Nearly 25% of primary care clinicians prefer another screening method over colonoscopy
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About one in four primary care clinicians surveyed preferred a stool-based test to a colonoscopy for colorectal cancer screening, according to findings published in Mayo Clinic Proceedings.
"Clinician recommendation is the most consistently identified factor associated with colorectal cancer screening," Lila J. Finney Rutten, PhD, a health services researcher at Mayo Clinic, told Healio Primary Care. “We know from previously published research that patients are more likely to comply with recommendations that align with their preferences. Thus, it is critical for clinicians to inform patients of their options for colorectal cancer screening and to engage patients in shared decision-making about which test is best for them.”
Finney Rutten and colleagues electronically surveyed 779 PCPs and 159 gastroenterologists on factors that influence their decision-making from Nov. 6, 2019, to Dec. 6, 2019. Of the PCP respondents, 72.5% were men, 66.2% were non-Hispanic white and 56% were aged 50 years or older. Among the GIs, 82.9% were men, 55.4% were non-Hispanic white and 52.2% were aged younger than 50 years.
Overall, colonoscopy was the most popular screening method for average-risk patients, but significantly more GIs preferred it over other methods compared with PCPs — 96.9% vs. 75.7% — according to Finney Rutten and colleagues. Results also showed that 12.2% of PCPs preferred a multi-target stool DNA test as their second screening method, followed by a fecal immunochemical test (7.3%) and a guaiac-based fecal occult blood test (4.8%). Only 3.2% of GIs chose a stool-based test as their preferred modality for average-risk patients, the researchers said.
Preference among all respondents shifted more toward noninvasive options for patients who were unable to undergo invasive procedures, were concerned about taking time off work, were unconvinced about the need for screening or who were refusing other screening recommendations, according to the researchers. Among PCPs specifically, respondents were less likely to prefer the stool test over the fecal immunochemical test and guaiac-based fecal test if they were from a larger clinical practice. Also, PCPs with more years of clinical experience, higher patient volumes (> 25 patients/day) and practicing in suburban and rural vs. urban settings were more likely to prefer the stool test to the fecal immunochemical test.
"Available colorectal cancer screening tests vary with regard to effectiveness, safety, convenience, cost and patient acceptability which supports the rationale for endorsing multiple screening options,” Finney Rutten said. “It has frequently been said that ‘the best screening test is the one that gets done’.”
References:
Finney Rutten LJ, et al. Mayo Clin Proc. 2021;doi:10.1016/j.mayocp.2021.06.028.
Primary care clinicians adjust recommendations for colorectal cancer screening to accommodate patient needs and preferences, study finds. https://newsnetwork.mayoclinic.org/discussion/primary-care-clinicians-adjust-recommendations-for-colorectal-cancer-screening-to-accommodate-patient-needs-and-preferences-study-finds/#. Published Dec. 14, 2021. Accessed Dec. 16, 2021.