DeBourcy Ann C, Lichtenberger Scott, Felton Susanne, Butterfield Kiel T, Ahnen Dennis J, Denberg Thomas D
Department of Medicine, University of Colorado at Denver School of Medicine, Aurora, CO 80045, USA.
J Gen Intern Med. 2008 Feb;23(2):169-74. doi: 10.1007/s11606-007-0480-1. Epub 2007 Dec 21.
In the United States, compliance with colorectal cancer (CRC) screening recommendations remains suboptimal. Professional organizations advocate use of shared decision making in screening test discussions, but strategies to facilitate informed choice in CRC screening have not been well elucidated.
The objectives of the study were to determine screening test preference among colonoscopy-naïve adults after considering a detailed, written presentation of fecal occult blood testing (FOBT) and colonoscopy and to assess whether their preferences are associated with demographic characteristics, attitudes, and knowledge.
The design of the study was a cross-sectional survey.
Colonoscopy-naïve supermarket shoppers age 40-79 in low- and middle-income, multiethnic neighborhoods in Denver, CO, reviewed a detailed, side-by-side description of FOBT and colonoscopy and answered questions about test preference, strength of preference, influence of physician recommendation, basic knowledge of CRC, and demographic characteristics.
Descriptive statistics characterized the sample, and bivariate and multivariable logistic regression analyses identified correlates of screening test preference. In a diverse sample of 323 colonoscopy-naïve adults, 53% preferred FOBT, and 47% preferred colonoscopy for CRC screening. Individuals of Latino ethnicity and those with lower educational attainment were more likely to prefer FOBT than non-Latino whites and those with at least some college. Almost half of the respondents felt "very strongly" about their preferences, and one third said they would adhere to their choice regardless of physician recommendation.
After considering a detailed, side-by-side comparison of the FOBT and colonoscopy, a large proportion of community-dwelling, colonoscopy-naïve adults prefer FOBT over colonoscopy for CRC screening. In light of professional guidelines and time-limited primary care visits, it is important to develop improved ways of facilitating informed patient decision making for CRC screening.
在美国，结直肠癌（CRC）筛查建议的依从性仍不理想。专业组织提倡在筛查测试讨论中采用共同决策，但尚未充分阐明促进CRC筛查中明智选择的策略。
本研究的目的是在考虑粪便潜血试验（FOBT）和结肠镜检查的详细书面介绍后，确定未接受过结肠镜检查的成年人对筛查测试的偏好，并评估他们的偏好是否与人口统计学特征、态度和知识相关。
本研究的设计为横断面调查。
科罗拉多州丹佛市中低收入、多民族社区年龄在40 - 79岁、未接受过结肠镜检查的超市购物者，阅读了FOBT和结肠镜检查的详细并排描述，并回答了有关测试偏好、偏好强度、医生建议的影响、CRC的基本知识以及人口统计学特征的问题。
描述性统计描述了样本，双变量和多变量逻辑回归分析确定了筛查测试偏好的相关因素。在323名未接受过结肠镜检查的成年人的多样化样本中，53%的人更喜欢FOBT，47%的人更喜欢结肠镜检查用于CRC筛查。拉丁裔个体和受教育程度较低的人比非拉丁裔白人和至少上过一些大学的人更有可能更喜欢FOBT。近一半的受访者对自己的偏好“非常强烈”，三分之一的人表示无论医生的建议如何，他们都会坚持自己的选择。
在对FOBT和结肠镜检查进行详细的并排比较后，很大一部分居住在社区、未接受过结肠镜检查的成年人在CRC筛查中更喜欢FOBT而不是结肠镜检查。鉴于专业指南和初级保健就诊时间有限，开发改进方法以促进患者在CRC筛查中做出明智决策非常重要。
