2012 HSR&D/QUERI National Conference Abstract
1055 — Attitudes towards Discontinuation of Colorectal Cancer Screening among Patients at Low Risk for Colorectal Cancer
Saini SD, Masserang E, and Forman J, Ann Arbor VA Center for Clinical Management Research; Antaki F, Detroit VAMC;
To understand patient attitudes towards discontinuation of colorectal cancer (CRC) screening in the setting of low predicted CRC risk.
We are performing an ongoing qualitative study (semi-structured interviews) of screen-eligible Veterans who: (1) are at average risk for CRC; and (2) have undergone prior negative screening for CRC. Patients were sampled from primary care clinic waiting rooms at the Ann Arbor and Detroit VA Medical Centers. Each patient was interviewed by a research assistant using a scenario-based interview guide that simulated a primary care clinic visit. Domains covered in this interview included: (1) prior experiences with CRC and CRC screening; (2) perceived risks and benefits of CRC screening; (3) attitudes towards individualized, benefit-based screening; and (4) attitudes towards discontinuation of screening in the setting of low predicted CRC risk. Interviews were audiotaped, transcribed, and reviewed independently by study team members. The study team then collaboratively identified themes from these interviews.
26 patients have been interviewed to date, 22 of which are included in the present analysis. Most patients (18/22) were 50-69 years of age, and most (19/22) were men. Patients initially described their interest in continued screening as high (median 8 on 0-10 scale). When presented with a hypothetical benefit-based screening program that recommended discontinuation of screening in low-risk patients, 11 patients were resistant to the concept of discontinuation of screening while 11 were receptive to this concept. Resistant patients differed from receptive patients in terms of beliefs about preventive care, prior personal experiences with CRC, and trust in risk prediction. These patients often cited the residual risk of CRC despite low risk and the relative ease of undergoing screening as factors underlying their desire to continue screening.
Some low-risk patients may be resistant to discontinuation of CRC screening despite supportive evidence and provider recommendation, presenting a potential barrier to successful implementation of benefit-based screening.
This work has important implications for implementation of benefit-based preventive care. Future work will quantify the prevalence of resistant patients in the screening population and examine the use of decision aids to help patients make more informed decisions about CRC screening.