Bringing an Organizational Perspective to the Optimal Number of Colorectal Cancer Screening Options Debate Authors
First Online: 14 September 2011 Received: 07 January 2011 Revised: 03 August 2011 Accepted: 29 August 2011 DOI:
Cite this article as: Partin, M.R., Powell, A.A., Burgess, D.J. et al. J GEN INTERN MED (2012) 27: 376. doi:10.1007/s11606-011-1870-y Abstract
Improving colorectal cancer (CRC) screening rates represents a challenge for primary care providers. Some have argued that offering a choice of CRC screening modes to patients will improve the currently low adherence rates. Others have raised concerns that offering numerous CRC screening options in practice could overwhelm patients and thus dampen enthusiasm for screening. In this article we assemble evidence to critically evaluate the relative merit of these opposing views. We find little evidence to support the hypothesis that the number of options offered will affect adherence (either positively or negatively), or that expanding the modalities offered beyond FOBT and colonoscopy will improve patient satisfaction. Therefore, we assert future decisions about the number of CRC screening modes to offer would more productively be focused on considerations such as what benefit the health-care organization would derive from offering additional modes, and how this change would affect other critical components of a successful screening program such as timely diagnosis. In light of these organizational level considerations, we agree with the assertion made by others that a screening program limited to FOBT and colonoscopy is likely to be ideal in most settings.
KEY WORDS colorectal neoplasms mass screening choice behavior decision making organizational decision making References
American Cancer Society. Colorectal Cancer Facts and Figures 2011–2013. 2011. Atlanta, GA, American Cancer Society.
Levin B, Lieberman DA, McFarland B, Andrews KS, Brooks D, Bond J, et al.
Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Gastroenterology. 2008;134(5):1570–95.
Rex DK, Johnson DA, Anderson JC, Schoenfeld PS, Burke CA, Inadomi JM.
American College of Gastroenterology guidelines for colorectal cancer screening 2009 [corrected]. Am J Gastroenterol. 2009;104(3):739–50.
US Preventive Services. Task Force. Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement. Annals of Internal Medicine. 2008;149(9):627–37.
Perlin JB. Under secretary for health's information letter: colorectal cancer screening (IL 10-2005-009). 5-16-2005. Washington DC, Department of Veterans Affairs, Veterans Health Administration.
Hoffman RM, Lewis CL, Pignone MP, Couper MP, Barry MJ, Elmore JG, et al.
Decision-making processes for breast, colorectal, and prostate cancer screening: the DECISIONS survey. Med Decis Making. 2010;30(5 Suppl):53S–64.
Ling BS, Trauth JM, Fine MJ, Mor MK, Resnick A, Braddock CH, et al.
Informed decision-making and colorectal cancer screening: is it occurring in primary care? Med Care. 2008;46(9 Suppl 1):S23–9.
Lafata JE, Divine G, Moon C, Williams LK.
Patient-physician colorectal cancer screening discussions and screening use. Am J Prev Med. 2006;31(3):202–9.
Yabroff KR, Klabunde CN, Yuan G, McNeel TS, Brown ML, Casciotti D et al. Are Physicians' Recommendations For Colorectal Cancer Screening Guideline-Consistent? Journal of General Internal Medicine 2010.
DeBourcy AC, Lichtenberger S, Felton S, Butterfield KT, Ahnen DJ, Denberg TD.
Community-based preferences for stool cards versus colonoscopy in colorectal cancer screening. J Gen Intern Med. 2008;23(2):169–74.
Marshall DA, Johnson FR, Phillips KA, Marshall JK, Thabane L, Kulin NA.
Measuring patient preferences for colorectal cancer screening using a choice-format survey. Value Health. 2007;10(5):415–30.
Sarfaty M, Feng S.
Choice of screening modality in a colorectal cancer education and screening program for the uninsured. J Cancer Educ. 2006;21(1):43–9.
Neugut AI, Lebwohl B.
Screening for colorectal cancer: the glass is half full. Am J Public Health. 2009;99(4):592–4.
Woolf SH, Jones RM, Rothemich SF, Krist A.
The priority is screening, not colonoscopy. Am J Public Health. 2009;99(12):2117–8.
Deci EL, Ryan RM. Intrinsic motivation and self-determination in human behavior. New York: Plenum; 1985.
Patall EA, Cooper H, Robinson JC.
The effects of choice on intrinsic motivation and related outcomes: a meta-analysis of research findings. Psychol Bull. 2008;134(2):270–300.
The theory of decision making. Psychol Bull. 1954;51(4):380–417.
The development of utility theory. The Journal of Political Economy. 1950;58(4):307–27.
Patient priorities in colorectal cancer screening decisions. Health Expect. 2005;8(4):334–44.
Hawley ST, Volk RJ, Krishnamurthy P, Jibaja-Weiss M, Vernon SW, Kneuper S.
Preferences for colorectal cancer screening among racially/ethnically diverse primary care patients. Med Care. 2008;46(9 Suppl 1):S10–6.
Leard LE, Savides TJ, Ganiats TG.
Patient preferences for colorectal cancer screening.[comment]. J Fam Pract. 1997;45(3):211–8.
Ling BS, Moskowitz MA, Wachs D, Pearson B, Schroy PC.
Attitudes toward colorectal cancer screening tests. Journal of General Internal Medicine. 2001;16(12):822–30.
Powell AA, Burgess DJ, Vernon SW, Griffin JM, Grill JP, Noorbaloochi S, et al.
Colorectal cancer screening mode preferences among US veterans. Prev Med. 2009;49(5):442–8.
Salkeld GP, Solomon MJ, Short L, Ward J.
Measuring the importance of attributes that influence consumer attitudes to colorectal cancer screening. ANZ J Surg. 2003;73(3):128–32.
Shokar NK, Carlson CA, Weller SC.
Informed decision making changes test preferences for colorectal cancer screening in a diverse population. Ann Fam Med. 2010;8(2):141–50.
El Serag HB, Petersen L, Hampel H, Richardson P, Cooper G.
The use of screening colonoscopy for patients cared for by the Department of Veterans Affairs. Arch Intern Med. 2006;166(20):2202–8.
National Institutes of Health. NIH State-of-the-Science Conference: Enhancing Use and Quality of Colorectal Cancer Screening - Program and Abstracts. 1–142. 2010. Bethesda, MD. 2-2-2010.
Office of Quality and Performance. Measure Master Report for National Quarter 2 FY 2009.
. 2009. Veteran's Health Administration (Accessed Aug. 2011).
Muraven M, Baumeister RF.
Self-regulation and depletion of limited resources: does self-control resemble a muscle? Psychol Bull. 2000;126(2):247–59.
Scheibehenne B, Greifeneder R, Todd PM. Can there ever be too many options? A meta-analytic review of choice overload. J Consumer Res 2010; 37.
White CM, Hoffrage U.
Testing the tyranny of too much choice against the allure of more choice. Psych Marketing. 2009;26(3):280–98.
The Multicentre Australian Colorectal-neoplasia Screening Group (MACS). A comparison of colorectal neoplasia screening tests: a multicentre community-based study of the impact of consumer choice. Med J Aust. 2006;184(11):546–50.
Segnan N, Senore C, Andreoni B, Arrigoni A, Bisanti L, Cardelli A, et al.
Randomized trial of different screening strategies for colorectal cancer: patient response and detection rates. J Natl Cancer Inst. 2005;97(5):347–57.
Inadomi JM, Vijan S, Janz NK, Fagerlin A, Thomas JP, Lin Y-V et al. Method of Recommendation for Colorectal Cancer Screening Strategies Impacts Adherence. AGA Abstracts , S-23. 2010.
Schroy PC III, Emmons K, Peters E, Glick JT, Robinson PA, Lydotes MA et al. The impact of a novel computer-based decision aid on shared decision making for colorectal cancer screening: A randomized trial. Med Decis Making 2010.
Dolan JG, Frisina S.
Randomized controlled trial of a patient decision aid for colorectal cancer screening. Med Decis Making. 2002;22(2):125–39.
Ruffin MT, Fetters MD, Jimbo M.
Preference-based electronic decision aid to promote colorectal cancer screening: results of a randomized controlled trial. Prev Med. 2007;45(4):267–73.
Griffith JM, Lewis CL, Brenner AR, Pignone MP.
The effect of offering different numbers of colorectal cancer screening test options in a decision aid: a pilot randomized trial. BMC Med Inform Decis Mak. 2008;8:4.
Pignone M, Harris R, Kinsinger L.
Videotape-based decision aid for colon cancer screening. A randomized, controlled trial. Ann Intern Med. 2000;133(10):761–9.
The bottom line: offer the colorectal cancer screening test that you can deliver. Gastrointest Endosc. 2007;65(4):646–7.
Fisher JA, Fikry C, Troxel AB.
Cutting cost and increasing access to colorectal cancer screening: another approach to following the guidelines. Cancer Epidemiol Biomarkers Prev. 2006;15(1):108–13.
Subramanian S, Bobashev G, Morris RJ.
When budgets are tight, there are better options than colonoscopies for colorectal cancer screening. Health Aff (Millwood). 2010;29(9):1734–40.
Gravel K, Legare F, Graham ID.
Barriers and facilitators to implementing shared decision-making in clinical practice: a systematic review of health professionals' perceptions. Implement Sci. 2006;1:16.
Lukas C, Holmes S, Cohen A, Restuccia J, Cramer I, Shwartz M, et al.
Transformational change in health care systems:An organizational model. Health Care Management Review. 2007;32(4):309–20.
Hoff G, Dominitz JA.
Contrasting US and European approaches to colorectal cancer screening: which is best? Gut. 2010;59(3):407–14.
Etzioni DA, Yano EM, Rubenstein LV, Lee ML, Ko CY, Brook RH, et al.
Measuring the quality of colorectal cancer screening: the importance of follow-up. Dis Colon Rectum. 2006;49(7):1002–10.
Fisher DA, Jeffreys A, Coffman CJ, Fasanella K.
Barriers to full colon evaluation for a positive fecal occult blood test. Cancer Epidemiol Biomarkers Prev. 2006;15(6):1232–5.
Garman KS, Jeffreys A, Coffman C, Fisher DA.
Colorectal cancer screening, comorbidity, and follow-up in elderly patients. Am J Med Sci. 2006;332(4):159–63.
Gellad ZF, Almirall D, Provenzale D, Fisher DA.
Time from positive screening fecal occult blood test to colonoscopy and risk of neoplasia. Dig Dis Sci. 2009;54(11):2497–502.
Jacobsen PB, Shibata D, Siegel EM, Druta M, Lee JH, Marshburn J, et al.
Measuring quality of care in the treatment of colorectal cancer: the Moffitt quality practice initiative. J Oncol Pract. 2007;3(2):60–5.
Jimbo M, Myers RE, Meyer B, Hyslop T, Cocroft J, Turner BJ, et al.
Reasons patients with a positive fecal occult blood test result do not undergo complete diagnostic evaluation. Ann Fam Med. 2009;7(1):11–6.
Malin JL, Schneider EC, Epstein AM, Adams J, Emanuel EJ, Kahn KL.
Results of the National Initiative for Cancer Care Quality: how can we improve the quality of cancer care in the United States? J Clin Oncol. 2006;24(4):626–34.
McConnell YJ, Inglis K, Porter GA.
Timely access and quality of care in colorectal cancer: are they related? Int J Qual Health Care. 2010;22(3):219–28.
Miglioretti DL, Rutter CM, Bradford SC, Zauber AG, Kessler LG, Feuer EJ, et al.
Improvement in the diagnostic evaluation of a positive fecal occult blood test in an integrated health care organization. Med Care. 2008;46(9 Suppl 1):S91–6.
Rao SK, Schilling TF, Sequist TD.
Challenges in the management of positive fecal occult blood tests. J Gen Intern Med. 2009;24(3):356–60.
Singh H, Daci K, Petersen LA, Collins C, Petersen NJ, Shethia A, et al.
Missed opportunities to initiate endoscopic evaluation for colorectal cancer diagnosis. Am J Gastroenterol. 2009;104(10):2543–54.
Singh H, Petersen LA, Daci K, Collins C, Khan M, El Serag HB. Reducing referral delays in colorectal cancer diagnosis: is it about how you ask? Qual Saf Health Care 2010.
Singh H, Kadiyala H, Bhagwath G, Shethia A, El Serag H, Walder A, et al.
Using a multifaceted approach to improve the follow-up of positive fecal occult blood test results. Am J Gastroenterol. 2009;104(4):942–52.
Jackson GL, Powell AA, Ordin DL, Schlosser JE, Murawsky J, Hersh J, et al.
Developing and sustaining quality improvement partnerships in the VA: The Colorectal Cancer Care Collaborative. Journal of General Internal Medicine. 2010;25(Suppl 1):38–43.
Hodgson DC, Fuchs CS, Ayanian JZ.
Impact of patient and provider characteristics on the treatment and outcomes of colorectal cancer. J Natl Cancer Inst. 2001;93(7):501–15.
Fenton JJ, Elmore JG, Buist DS, Reid RJ, Tancredi DJ, Baldwin LM.
Longitudinal adherence with fecal occult blood test screening in community practice. Ann Fam Med. 2010;8(5):397–401.
Larson MF, Ko CW, Dominitz JA.
Effectiveness of a provider reminder on fecal occult blood test follow-up. Dig Dis Sci. 2009;54(9):1991–6.
Powell AA, Ordin DL, Schlosser JE, Gravely AA, Partin MR. Improving rates of timely follow-up after positive fecal occult blood tests. American Journal of Preventative Medicine 2009. Copyright information
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