LAKE TAHOE, CALIF. — Patients may be more likely to be screened for colon cancer if physicians schedule colonoscopies and tell the patients to show up rather than giving them a choice of screening options, Dr. John M. Inadomi said at a meeting on gastroenterology and hepatology sponsored by the University of California, Davis.
That's what he and associates at the University of California, San Francisco, found in a small pilot study, and they plan to study this further in a much larger trial, he said.
In the pilot study, they randomized 41 subjects and followed them for 6 months to see how many completed the colon cancer screening tests. None of the patients who either chose or were told to get three fecal occult blood tests (FOBTs) plus flexible sigmoidoscopy completed both. “So first of all, if you're trying to get people to do both FOBT and flex sig, forget it,” said Dr. Inadomi, chief of clinical gastroenterology at San Francisco General Hospital and director of GI Outcomes and Health Services Research at the university.
Patients who were told to get a colonoscopy were twice as likely to get one as patients who were counseled about screening options and who chose to get a colonoscopy, he added.
Fifteen patients in the “choice” arm of the study were counseled by a nurse-specialist who recited a scripted message designed to help patients choose between getting a colonoscopy or getting three FOBTs plus a flexible sigmoidoscopy. If the FOBTs or the flexible sigmoidoscopy was positive, the patient was to get a colonoscopy.
Nine patients chose colonoscopy, and three of them (33%) got the test. Of the six patients who chose FOBTs plus flexible sigmoidoscopy, two completed the FOBTs and two underwent flexible sigmoidoscopy but none completed both tests.
Among 26 patients in the “no choice” arm, 13 were told to show up for a colonos-copy and 9 patients (69%) did so. Of the 13 patients who were told to get FOBTs plus flexible sigmoidoscopy, 1 patient completed the FOBTs and 4 patients underwent the sigmoidoscopy, but none got both tests.
Newer screening options have joined these mainstays and further confuse patients when given a choice, Dr. Inadomi noted. The lack of a clearly defined preference leads people to defer a decision when given a choice. “The main thing to improve adherence with screening guidelines is to schedule patients for the test that they will complete,” he said.