Researchers presumed that recommending just one or the other would send a clear signal and be more effective than giving patients a choice.
They were wrong.
What they found instead was that patients who were recommended to get a colonoscopy only followed through 38 percent of the time. Compare that to patients who got a recommendation for FOBT and got screened 67 percent of the time, or those given a choice between the two -- who underwent screening 69 percent of the time.
As the researchers say, “Giving choices through shared decision making can improve adherence by increasing patient engagement and allowing for individual patient preferences.”
The finding was surprising because previous studies had suggested that talking to patients about the wide range of available options often led them to do nothing at all. As the study authors put it, “[E]vidence also illustrates that providing options of similar value and characteristics can sometimes have a negative impact on adherence due to people defaulting to inertia, presumably because of confusion or indecision between choices.”
Dr. Theodore Levin, who heads up Colon Cancer Screening for Kaiser Permanente in Northern California, wrote a commentary in response to the publication. In his words:
“If having too many choices leads to confusion, the study by Inadomi et al. demonstrates that not having enough choice may lead to inaction when the only choice is colonoscopy ... When it comes to CRC screening, providing an option other than colonoscopy for our patients is not overwhelming, but necessary.”
“What should physicians recommend when talking with patients about CRC? The psychology literature has noted that too much choice is a problem in current society. Patients may be overwhelmed by the options and feel that no option is perfect and therefore choose to do nothing out of confusion. However, every option for CRC screening has its own unique strengths and limitations. A patient-centered approach would take each patient’s perspective into account when designing a screening strategy.”
The study further looked at differences among groups of people to find barriers to screening. The authors wrote:
“Prior studies reported low CRC screening rates among racial/ethnic minorities, especially among Asians, Latinos, and African Americans. While the present study confirms the disparity among African Americans, we observed higher adherence among Asians and Latinos than for whites. Our population had established access to health care, which may have reduced these racial differences.”
The study authors also found that people who did their patient-doctor visits in Spanish, Cantonese, or Mandarin were more likely to get screened than people of the same race/ethnicity who chose to do their visits in English.
And, not surprisingly, patients with insurance (public or private) completed screening more often than those without insurance.
