Talking to patients about screening colonoscopy--where conversations fall short

A physician's recommendation is a powerful motivator for a patient to undergo colonoscopy for colorectal cancer screening, yet little is known about how physicians address this topic.

We recruited 30 primary care physicians and physicians-in-training from 4 practices to counsel a "patient," simulated by a researcher, regarding the need for screening colonoscopy. Audiotapes of the encounters were transcribed. Preserving physician anonymity, we assessed each encounter for key informational points, positive or negative message framing, type of numeracy information, and use of colloquial or technical language.

Most physicians (>/=80%) discussed the benefits of colorectal cancer screening, its status as a standard exploratory procedure, and the use of sedation. However, few (<20%) addressed the risks of colonoscopy, the nuances of scheduling, or the need for dietary and medication changes. Nearly all physicians (98%) used messages that focused on the positive aspects of screening, and many (67%) also used messages that focused on the risk of not screening. Numeracy information generally was expressed simply, but half of physicians used statistical terms. Half used colloquial terms to describe the prep and procedure.

Though most physicians used positive, simple terms to describe colonoscopy, they often omitted key information. Correcting for the areas of insufficient information found in our study--perhaps with supplementary educational sources--will help ensure that patients are adequately prepared for colonoscopy.