Determinants of colorectal cancer screening use, attempts, and non-use

Relatively little is known about the experiences and preferences of users and those who attempt colorectal cancer (CRC) screening. This study describes factors influencing CRC screening decisions among users, attempters, attempter users (individuals who both attempted and completed at least one screening procedure), and non-users; identifies factors interfering with test completion; and describes correlates of screening preferences.

A primarily stratified random sample of patients from the University of Michigan Health System clinics, Ann Arbor, Michigan, with oversampling of FOBT attempters, completed a mailed questionnaire in fall, 2003. Descriptive and multivariate approaches evaluated factors influencing screening use and preferences.

"Accuracy of results" was reported most often as important when deciding about CRC screening regardless of screening status. The importance of psychological decisional factors differed significantly by screening status (P<0.05). Among factors interfering with test completion, 38.5% attempting FOBT reported they "forgot" whereas 29.8% attempting colonoscopy were "afraid of pain." Approximately 56.3% indicated a preference for a CRC test: respondents who considered "discomfort" important preferred FOBT (OR: 0.39, 95% CI: 0.17, 0.87); those with a prior colonoscopy preferred an invasive test (OR: 6.50, 95% CI: 2.90, 14.50).

To improve adherence to CRC screening recommendations, physicians should tailor discussions to patients' prior experiences and test-specific concerns and elicit preferences for screening.