Patient-physician colorectal cancer screening discussions and screening use

Background: Little is known about patient-physician colorectal cancer (CRC) screening discussions or how discussion content affects screening use. Analyses conducted in 2004-2005 of patient-physician CRC screening discussion content and its association with screening use are described. Methods: A mailed survey and retrospective claims data were used to compile information on insured, primary care patients aged 50 to 70 years (n =4966). The survey collected information on patient-physician CRC screening discussion content (including the 5A's: assess, advise, agree, assist, and arrange). Survey responses were linked with 5-year retrospective claims data (ending December 31, 2003) on CRC screening use. Among patients reporting screening discussions, generalized estimating equation approaches were used to estimate the association of discussion content with screening use. Results: Among those reporting discussion information (n =2463), 80% reported discussing CRC screening with their physician. The content of these discussions varied, and only 54% used CRC screening. Multivariable model results indicated that the likelihood of screening was greater among patients reporting help scheduling an appointment (assist) (odds ratio [OR]= 2.69, 95% confidence interval [CI]=1.95-3.72) and those reporting a discussion of results or follow-up (arrange) (OR=1.63, 95% CI=1.18-2.24), and lower among patients offered a choice among screening modalities (agree) (OR=0.57, 95% CI=0.37-0.86) as well as among those who wanted more screening information (OR=0.65, 95% CI=0.43-0.97). Conclusions: Not all patient-physician CRC screening discussions result in CRC screening use. It is important to understand which aspects of shared decision making and discussion content are likely to increase informed and value-concordant decisions to participate in recommended evidence-based CRC screening.