MONTREAL — Primary care physicians referring patients for routine colorectal cancer screening may see better adherence, particularly among men, if they consider patient preference regarding screening modality, reported Maida Sewitch, Ph.D., from McGill University, Montreal. However, the picture is less clear for women.
In a study of 203 primary care patients referred for colorectal cancer screening (40% male, mean age 64 years), overall adherence was 52%, Dr. Sewitch reported in a poster at Canadian Digestive Diseases Week.
For both genders combined, the strongest predictor of adherence was a physician's referral that matched a patient's preferred screening modality (adjusted odds ratio 3.64), she said. However, the results looked quite different when analyzed according to patient gender.
“What we found was that the people for whom matched modality was important were the men—and that men who were matched on modality were 3.5 times more likely to adhere to screening referral than men who were not matched. But women didn't care about modality. We didn't expect that at all,” Dr. Sewitch said in an interview.
The four choices of screening modality offered in the study were colonoscopy, double contrast barium enema, flexible sigmoidoscopy, and fecal occult blood testing (FOBT). The most commonly requested modality was FOBT, she said.
Although matching the referral modality to patient preference increased the odds of screening adherence in men (AOR 3.49), it only had a slight impact in women (AOR 1.24), she said. Instead, the predictor of female adherence to screening was past history of screening (AOR 2.1), she reported.
Women may “have more trust in their physician's recommendation, and a past history of screening may demystify the experience, whereas men want what they want,” Dr. Sewitch said. “It might have a lot to do with control.
“Physicians should be speaking with patients about what they want. If they're going to recommend some kind of colorectal cancer screening, they can ask their patients what they want to do and give their referral based on that,” she said.
A second poster presented at the meeting described an investigation of patient preference regarding the timing of a precolonoscopy consult with a gastroenterologist. A total of 125 average-risk patients (66% male, mean age 60 years) participated in the study, with 21% receiving a gastroenterology consult on a different day (DD) previous to their colonoscopy, and 79% receiving the consult on the same day (SD), just before their colonoscopy.
Patients were asked to complete a questionnaire after their colonoscopy regarding their preference for a DD or SD consult, reported Dr. Liliana Oliveira from the University of Ottawa. The study found that patient preferences appeared to be affected only by prior consultation experience. Among patients who had an SD consult, 86% indicated a preference for this practice, and among those who had a DD consult, 61.5% preferred this practice; these findings were significant.
She stressed that SD consultation is only intended for average-risk patients. Although SD consultation is common, she said it remains somewhat controversial.