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Bringing an Organizational Perspective to the Optimal Number of Colorectal Cancer Screening Options Debate

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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.

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References

  1. American Cancer Society. Colorectal Cancer Facts and Figures 2011–2013. 2011. Atlanta, GA, American Cancer Society.

  2. 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.

    Article  PubMed  CAS  Google Scholar 

  3. 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.

    Article  PubMed  Google Scholar 

  4. 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.

    Google Scholar 

  5. 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.

  6. 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.

    Article  PubMed  Google Scholar 

  7. 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.

    Article  PubMed  Google Scholar 

  8. 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.

    Article  PubMed  Google Scholar 

  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.

  10. 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.

    Article  PubMed  Google Scholar 

  11. 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.

    Article  PubMed  Google Scholar 

  12. 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.

    Article  PubMed  Google Scholar 

  13. Neugut AI, Lebwohl B. Screening for colorectal cancer: the glass is half full. Am J Public Health. 2009;99(4):592–4.

    Article  PubMed  Google Scholar 

  14. Woolf SH, Jones RM, Rothemich SF, Krist A. The priority is screening, not colonoscopy. Am J Public Health. 2009;99(12):2117–8.

    Article  PubMed  Google Scholar 

  15. Deci EL, Ryan RM. Intrinsic motivation and self-determination in human behavior. New York: Plenum; 1985.

    Google Scholar 

  16. 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.

    Article  PubMed  Google Scholar 

  17. Edwards W. The theory of decision making. Psychol Bull. 1954;51(4):380–417.

    Article  PubMed  CAS  Google Scholar 

  18. Stigler GJ. The development of utility theory. The Journal of Political Economy. 1950;58(4):307–27.

    Article  Google Scholar 

  19. Dolan JG. Patient priorities in colorectal cancer screening decisions. Health Expect. 2005;8(4):334–44.

    Article  PubMed  Google Scholar 

  20. 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.

    Article  PubMed  Google Scholar 

  21. Leard LE, Savides TJ, Ganiats TG. Patient preferences for colorectal cancer screening.[comment]. J Fam Pract. 1997;45(3):211–8.

    PubMed  CAS  Google Scholar 

  22. 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.

    Article  PubMed  CAS  Google Scholar 

  23. 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.

    Article  PubMed  Google Scholar 

  24. 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.

    Article  PubMed  Google Scholar 

  25. 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.

    Article  PubMed  Google Scholar 

  26. 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.

    Article  PubMed  Google Scholar 

  27. 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.

  28. Office of Quality and Performance. Measure Master Report for National Quarter 2 FY 2009. http://10.191.23.134/MeasureMaster/MMReport.asp . 2009. Veteran's Health Administration (Accessed Aug. 2011).

  29. Muraven M, Baumeister RF. Self-regulation and depletion of limited resources: does self-control resemble a muscle? Psychol Bull. 2000;126(2):247–59.

    Article  PubMed  CAS  Google Scholar 

  30. 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.

  31. White CM, Hoffrage U. Testing the tyranny of too much choice against the allure of more choice. Psych Marketing. 2009;26(3):280–98.

    Article  Google Scholar 

  32. 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.

    Google Scholar 

  33. 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.

    Article  PubMed  Google Scholar 

  34. 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.

  35. 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.

  36. Dolan JG, Frisina S. Randomized controlled trial of a patient decision aid for colorectal cancer screening. Med Decis Making. 2002;22(2):125–39.

    PubMed  Google Scholar 

  37. 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.

    Article  PubMed  Google Scholar 

  38. 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.

    Article  PubMed  Google Scholar 

  39. 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.

    PubMed  CAS  Google Scholar 

  40. Fisher DA. The bottom line: offer the colorectal cancer screening test that you can deliver. Gastrointest Endosc. 2007;65(4):646–7.

    Article  PubMed  Google Scholar 

  41. 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.

    Article  PubMed  Google Scholar 

  42. 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.

    Article  Google Scholar 

  43. 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.

    Article  PubMed  Google Scholar 

  44. 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.

    PubMed  Google Scholar 

  45. Hoff G, Dominitz JA. Contrasting US and European approaches to colorectal cancer screening: which is best? Gut. 2010;59(3):407–14.

    Article  PubMed  Google Scholar 

  46. 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.

    Article  PubMed  Google Scholar 

  47. 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.

    Article  PubMed  Google Scholar 

  48. 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.

    Article  PubMed  Google Scholar 

  49. 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.

    Article  PubMed  Google Scholar 

  50. 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.

    Article  PubMed  Google Scholar 

  51. 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.

    Article  PubMed  Google Scholar 

  52. 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.

    Article  PubMed  Google Scholar 

  53. 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.

    Article  PubMed  Google Scholar 

  54. 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.

    Article  PubMed  Google Scholar 

  55. 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.

    Article  PubMed  Google Scholar 

  56. 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.

    Article  PubMed  Google Scholar 

  57. 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.

  58. 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.

    Article  PubMed  Google Scholar 

  59. 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.

    Article  PubMed  Google Scholar 

  60. 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.

    Article  PubMed  CAS  Google Scholar 

  61. 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.

    Article  PubMed  Google Scholar 

  62. 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.

    Article  PubMed  Google Scholar 

  63. 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.

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Acknowledgements

This research was supported by two Veterans Affairs Health Services Research and Development grants: IIR 08–334 awarded to Dr. Partin and the VA HSR&D Career Development Award CDA 08–024 granted to Dr. Powell. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

Conflict of interests

None disclosed.

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Authors and Affiliations

  1. Center for Chronic Disease Outcomes Research, Minneapolis VA Medical Center, Minneapolis, MN, USA

    Melissa R. Partin PhD, Adam A. Powell PhD, Diana J. Burgess PhD & Timothy J. Wilt MD, MPH

  2. Department of Medicine, University of Minnesota, Minneapolis, MN, USA

    Melissa R. Partin PhD, Adam A. Powell PhD, Diana J. Burgess PhD & Timothy J. Wilt MD, MPH

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  1. Melissa R. Partin PhD
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  2. Adam A. Powell PhD
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  3. Diana J. Burgess PhD
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  4. Timothy J. Wilt MD, MPH
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Correspondence to Melissa R. Partin PhD.

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Partin, M.R., Powell, A.A., Burgess, D.J. et al. Bringing an Organizational Perspective to the Optimal Number of Colorectal Cancer Screening Options Debate. J GEN INTERN MED 27, 376–380 (2012). https://doi.org/10.1007/s11606-011-1870-y

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