More patient options doesn't improve colorectal cancer screening rates

Providing patients more testing choices does not increase their participation in colorectal cancer screening—but the way clinician’s framed those choices did, according to a new study published in JAMA Network Open.

Among a group of more than 400 patients who were overdue for screening, more chose to forgo colonoscopy—the gold standard for screening—when they were presented the option of at-home fecal immunochemical testing (FIT).

"As clinicians, we should think carefully about the choices that we offer to patients: While they're well-meaning and seemingly more patient-centered, choices may actually be overwhelming and could impede decision-making," said lead author Shivan Mehta, MD, MBA, associate chief innovation officer at Penn Medicine, in a prepared statement. "It is important for us to simplify choices as much as possible, but also think about how we frame them."

Colorectal cancer remains the second deadliest form of the disease in the U.S., but one in three people are not up to date on their screening, Meta and colleagues added. For their study, the team wanted to know If offering FIT—an at-home stool test that can be mailed to a lab in place of a colonoscopy—would push patients to complete screening.

"We know from behavioral science that we all tend to overweigh present-time risks as compared to future benefits," Mehta explained. "In the short term, it's easier to get stool testing done, but the need to do it yearly presents more opportunities for a patient to get behind on their screening. Conversely, colonoscopies are more challenging in the short term, but they keep patients up-to-date longer."

The researchers included 438 patients who received a letter from their primary care physician about the benefits of screening in their study; they were separated equally into three study arms. Participants in the first group received a phone number, in addition to the letter, to call and schedule a colonoscopy. If they didn’t schedule one within four weeks, they received another letter with the same information.

Those in the second group were also given a number to call for scheduling a colonoscopy. If they did not schedule an exam within four weeks, they were also mailed another letter, along with a FIT kit.

Patients in the third arm were provided the number to schedule a colonoscopy and a FIT kit at the same time. If they didn’t utilize either test, they received a follow-up letter with information about both methods.

Overall, as FIT kits were more readily available, fewer patient chose colonoscopies. In the first arm, 90% of completed screenings utilized colonoscopy, 52% did so in the second group and 38% in the third. Overall screening rates, the authors noted, did not change much throughout the three groups.

“Our results show that subtle changes in sequencing or defaults can alter patient decision making related to preventive health,” the researchers concluded. “This has implications for CRC screening, as well as for many other clinical areas where clinicians have to guide patients on choices with many characteristics and trade-offs.”