Journal of General Internal Medicine

, Volume 14, Issue 7, pp 432–437

Patient preferences for colon cancer screening

  • Michael Pignone
  • Dawn Bucholtz
  • Russell Harris
Original Articles

DOI: 10.1046/j.1525-1497.1999.00018.x

Cite this article as:
Pignone, M., Bucholtz, D. & Harris, R. J GEN INTERN MED (1999) 14: 432. doi:10.1046/j.1525-1497.1999.00018.x


OBJECTIVE: To measure patient preferences for four different screening strategies: annual fecal occult blood testing (FOBT) alone; flexible sigmoidoscopy (FSIG) every 5 years alone; both annual FOBT and FSIG every 5 years; or no screening.

DESIGN: Survey.

SETTING: University internal medicine clinic.

PATIENTS: Convenience sample of 146 adults (aged 50–75 years) with no previous history of colon cancer.

INTERVENTION: Three-part educational program on colon cancer screening administered verbally by trained research assistants.

MEASUREMENTS AND MAIN RESULTS: Patient preferences for screening were measured at three points: after descriptive information about colon cancer and screening options (testing procedure information); after information about test performance but with no out-of-pocket costs (test performance information); and finally with hypothetical out-of-pocket costs (cost information). After only descriptive test information, the most popular strategies were FOBT alone (45%) or both tests (38%). Fewer patients preferred FSIG alone (13%). After information about test performance, more subjects preferred both tests (47%), and fewer subjects preferred FOBT alone (36%) (p=.12). With hypothetical out-of-pocket costs, the proportion preferring FOBT alone increased to 53%, while those preferring both tests decreased to 31% (p<.001). Less than 5% of patients preferred no screening.

CONCLUSIONS: Patient preferences for colon cancer screening were modestly sensitive to information about test performance and strongly sensitive to out-of-pocket costs. The heterogeneity of patients’ preferences for how to be screened supports informed shared decision making as a possible means of improving colon cancer screening.

Key Words

colon cancerscreeningpatient preferencesshared decision making

Copyright information

© Society of General Internal Medicine 1999

Authors and Affiliations

  • Michael Pignone
    • 1
  • Dawn Bucholtz
    • 2
  • Russell Harris
    • 1
  1. 1.the Division of General Internal Medicine and RWJ Clinical Scholars ProgramUniversity of North Carolina School of MedicineChapel Hill
  2. 2.Department of Health Behavior and Health EducationUniversity of North Carolina School of Public HealthChapel Hill