Journal of General Internal Medicine

, 24:1228

Behind Closed Doors: Physician-Patient Discussions About Colorectal Cancer Screening


    • Division of Health Behavior ResearchWashington University, School of Medicine
  • L. Kay Bartholomew
    • School of Public HealthUniversity of Texas-Houston
  • Anthony J. Greisinger
    • Kelsey Research Foundation
  • Gilda G. Medina
    • School of Public HealthUniversity of Texas-Houston
  • Sarah T. Hawley
    • School of MedicineUniversity of Michigan
  • Paul Haidet
    • The Houston Center for Quality of Care and Utilization Studies at the DeBakey VA Medical Center and Baylor College of Medicine
  • Judith L. Bettencourt
    • School of Public HealthUniversity of Texas-Houston
  • Navkiran K. Shokar
    • University of Texas Medical Branch
  • Bruce S. Ling
    • School of MedicineUniversity of Pittsburgh
  • Sally W. Vernon
    • School of Public HealthUniversity of Texas-Houston
Original Article

DOI: 10.1007/s11606-009-1108-4

Cite this article as:
McQueen, A., Bartholomew, L.K., Greisinger, A.J. et al. J GEN INTERN MED (2009) 24: 1228. doi:10.1007/s11606-009-1108-4



Despite the availability of multiple effective screening tests for colorectal cancer, screening rates remain suboptimal. The literature documents patient preferences for different test types and recommends a shared decision-making approach for physician-patient colorectal cancer screening (CRCS) discussions, but it is unknown whether such communication about CRCS preferences and options actually occurs in busy primary-care settings.


Describe physician-patient CRCS discussions during a wellness visit.


Cross-sectional; patients audio-recorded with physicians.


A subset of patients (N = 64) participating in a behavioral intervention trial designed to increase CRCS who completed a wellness visit during the trial with a participating physician (N = 8).


Transcripts were analyzed using qualitative methods.


Physicians in this sample consistently recommended CRCS, but focused on colonoscopy. Physicians did not offer a fecal occult blood test alone as a screening choice, which may have created missed opportunities for some patients to get screened. In this single visit, physicians’ communication processes generally precluded discussion of patients’ test preferences and did not facilitate shared decision-making. Patients’ questions indicated their interest in different CRCS test types and appeared to elicit more information from physicians. Some patients remained resistant to CRCS after discussing it with a physician.


If a preference for colonoscopy is widespread among primary-care physicians, the implications for intervention are either to prepare patients for this preference or to train physicians to offer options when recommending screening to patients.


colorectal cancer screeningphysician-patient communicationshared decision-makingqualitative researchinterventions

Copyright information

© Society of General Internal Medicine 2009