Patient-rated importance and receipt of information for colorectal cancer screening

Background: Physician recommendation is one of the most important determinants of obtaining colorectal cancer (CRC) screening; however, little is known about the degree to which CRC screening discussions include information that patients report as important to guide screening decisions. This study examines and compares both patient rated importance and physician communication of key information elements about CRC screening during annual physical examinations. Methods: Design: Cross-sectional cohort. Setting: 26 ambulatory clinics of an integrated delivery system in the Midwest. Participants: 64 primary care physicians and 415 patients aged 50 to 80 due for CRC screening. Patients completed a previsit survey to assess importance of specific information when making a preventive screening decision. Visits were audio recorded to assess the content of screening discussions. Results: Most patients rated test accuracy (85%), testing alternatives (83%), the pros and cons of testing (86%), and the testing process (78%) very important when making preventive screening decisions. Ninety-one percent of visits included a CRC screening discussion; however, CRC screening talk rarely included information that patients rated as important. Physicians infrequently asked whether patients had questions pertaining to CRC screening (5%); however, 49% of patients asked a CRC screening question, with the vast majority pertaining to screening logistics. Conclusions: Audio recordings confirm that discussions of CRC screening are often lacking information that patients indicate is very important when making preventive health decisions and patient questions during the visit are not eliciting information to fill the gap. Impact: These findings provide actionable information to improve CRC screening discussions.