Risk assessment and clinical decision making for colorectal cancer screening

Background Shared decision making (SDM) related to test preference has been advocated as a potentially effective strategy for increasing adherence to colorectal cancer (CRC) screening, yet primary care providers (PCPs) are often reluctant to comply with patient preferences if they differ from their...

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Bibliographic Details
Published in:Health expectations : an international journal of public participation in health care and health policy 2015-10, Vol.18 (5), p.1327-1338
Main Authors: Schroy, Paul C., Caron, Sarah E., Sherman, Bonnie J., Heeren, Timothy C., Battaglia, Tracy A.
Format: Article
Language:English
Subjects:
Age
Aged
Cancer
Cancer screening
Clinical assessment
Clinical decision making
Colonoscopy
Colorectal cancer
Colorectal Neoplasms - prevention & control
Cross-Sectional Studies
Decision Making
Early Detection of Cancer - utilization
Female
Grounded Theory
Group decision making
Health care
Health Policy
Humans
Interviews as Topic
Male
Medical personnel
Medical screening
Middle Aged
Minority Groups
Original
Original Research Papers
Patient Participation
Patients
physician decision support
Polls & surveys
Preferences
Primary care
Receptivity
Risk analysis
Risk assessment
Risk Assessment - methods
Risk factors
Risk perception
Stratification
Treatment preferences
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Summary:Background Shared decision making (SDM) related to test preference has been advocated as a potentially effective strategy for increasing adherence to colorectal cancer (CRC) screening, yet primary care providers (PCPs) are often reluctant to comply with patient preferences if they differ from their own. Risk stratification advanced colorectal neoplasia (ACN) provides a rational strategy for reconciling these differences. Objective To assess the importance of risk stratification in PCP decision making related to test preference for average‐risk patients and receptivity to use of an electronic risk assessment tool for ACN to facilitate SDM. Design Mixed methods, including qualitative key informant interviews and a cross‐sectional survey. Participants PCPs at an urban, academic safety‐net institution. Main Measures Screening preferences, factors influencing patient recommendations and receptivity to use of a risk stratification tool. Key Results Nine PCPs participated in interviews and 57 completed the survey. Despite an overwhelming preference for colonoscopy by 95% of respondents, patient risk (67%) and patient preferences (63%) were more influential in their decision making than patient comorbidities (31%; P 
ISSN:1369-6513
1369-7625
DOI:10.1111/hex.12110