Abstract: Adherence to Colorectal Cancer Screening: A Randomized Clinical Trial of Competing Strategies

 Abstract: Adherence to Colorectal Cancer Screening: A Randomized Clinical Trial of Competing Strategies

""We have seen benefit from colon cancer screening with fewer people dying from it," said Dr. Theodore Levin, (MedicineNet quote) a gastroenterologist at the Kaiser Permanente Medical Center in Walnut Creek, Calif., and the author of an accompanying journal editorial. "If we want to raise our screening rates then we need to offer people choices other than colonoscopy."

Adherence to Colorectal Cancer Screening
A Randomized Clinical Trial of Competing Strategies

Background  Despite evidence that several colorectal cancer (CRC) screening strategies can reduce CRC mortality, screening rates remain low. This study aimed to determine whether the approach by which screening is recommended influences adherence.

Methods  We used a cluster randomization design with clinic time block as the unit of randomization. Persons at average risk for development of CRC in a racially/ethnically diverse urban setting were randomized to receive recommendation for screening by fecal occult blood testing (FOBT), colonoscopy, or their choice of FOBT or colonoscopy. The primary outcome was completion of CRC screening within 12 months after enrollment, defined as performance of colonoscopy, or 3 FOBT cards plus colonoscopy for any positive FOBT result. Secondary analyses evaluated sociodemographic factors associated with completion of screening.

Results  A total of 997 participants were enrolled; 58% completed the CRC screening strategy they were assigned or chose. However, participants who were recommended colonoscopy completed screening at a significantly lower rate (38%) than participants who were recommended FOBT (67%) (P < .001) or given a choice between FOBT or colonoscopy (69%) (P < .001). Latinos and Asians (primarily Chinese) completed screening more often than African Americans. Moreover, nonwhite participants adhered more often to FOBT, while white participants adhered more often to colonoscopy.

Conclusions  The common practice of universally recommending colonoscopy may reduce adherence to CRC screening, especially among racial/ethnic minorities. Significant variation in overall and strategy-specific adherence exists between racial/ethnic groups; however, this may be a proxy for health beliefs and/or language. These results suggest that patient preferences should be considered when making CRC screening recommendations.