Behind closed doors: Physician-patient discussions about colorectal cancer screening

Amy McQueen, L. Kay Bartholomew, Anthony J. Greisinger, Gilda G. Medina, Sarah T. Hawley, Paul Haidet, Judith L. Bettencourt, Navkiran K. Shokar, Bruce S. Ling, Sally W. Vernon

Research output: Contribution to journalArticle

71 Citations (Scopus)

Abstract

Background: Despite the availability of multiple effective screening tests for colorectal cancer, screening rates remain suboptimal. The literature documents patient preferences for different test types and recommends a shared decision-making approach for physician-patient colorectal cancer screening (CRCS) discussions, but it is unknown whether such communication about CRCS preferences and options actually occurs in busy primary-care settings. Objective: Describe physician-patient CRCS discussions during a wellness visit. Design: Cross-sectional; patients audio-recorded with physicians. Participants: A subset of patients (N=64) participating in a behavioral intervention trial designed to increase CRCS who completed a wellness visit during the trial with a participating physician (N=8). Approach: Transcripts were analyzed using qualitative methods. Results: Physicians in this sample consistently recommended CRCS, but focused on colonoscopy. Physicians did not offer a fecal occult blood test alone as a screening choice, which may have created missed opportunities for some patients to get screened. In this single visit, physicians' communication processes generally precluded discussion of patients' test preferences and did not facilitate shared decision-making. Patients' questions indicated their interest in different CRCS test types and appeared to elicit more information from physicians. Some patients remained resistant to CRCS after discussing it with a physician. Conclusion: If a preference for colonoscopy is widespread among primary-care physicians, the implications for intervention are either to prepare patients for this preference or to train physicians to offer options when recommending screening to patients.

Original languageEnglish (US)
Pages (from-to)1228-1235
Number of pages8
JournalJournal of general internal medicine
Volume24
Issue number11
DOIs
StatePublished - Nov 1 2009

Fingerprint

Early Detection of Cancer
Colorectal Neoplasms
Physicians
Patient Preference
Colonoscopy
Decision Making
Communication
Occult Blood
Primary Care Physicians
Hematologic Tests
Primary Health Care

All Science Journal Classification (ASJC) codes

  • Internal Medicine

Cite this

McQueen, A., Bartholomew, L. K., Greisinger, A. J., Medina, G. G., Hawley, S. T., Haidet, P., ... Vernon, S. W. (2009). Behind closed doors: Physician-patient discussions about colorectal cancer screening. Journal of general internal medicine, 24(11), 1228-1235. https://doi.org/10.1007/s11606-009-1108-4
McQueen, Amy ; Bartholomew, L. Kay ; Greisinger, Anthony J. ; Medina, Gilda G. ; Hawley, Sarah T. ; Haidet, Paul ; Bettencourt, Judith L. ; Shokar, Navkiran K. ; Ling, Bruce S. ; Vernon, Sally W. / Behind closed doors : Physician-patient discussions about colorectal cancer screening. In: Journal of general internal medicine. 2009 ; Vol. 24, No. 11. pp. 1228-1235.
@article{5acd512e84784a549b7799699182b6fc,
title = "Behind closed doors: Physician-patient discussions about colorectal cancer screening",
abstract = "Background: Despite the availability of multiple effective screening tests for colorectal cancer, screening rates remain suboptimal. The literature documents patient preferences for different test types and recommends a shared decision-making approach for physician-patient colorectal cancer screening (CRCS) discussions, but it is unknown whether such communication about CRCS preferences and options actually occurs in busy primary-care settings. Objective: Describe physician-patient CRCS discussions during a wellness visit. Design: Cross-sectional; patients audio-recorded with physicians. Participants: A subset of patients (N=64) participating in a behavioral intervention trial designed to increase CRCS who completed a wellness visit during the trial with a participating physician (N=8). Approach: Transcripts were analyzed using qualitative methods. Results: Physicians in this sample consistently recommended CRCS, but focused on colonoscopy. Physicians did not offer a fecal occult blood test alone as a screening choice, which may have created missed opportunities for some patients to get screened. In this single visit, physicians' communication processes generally precluded discussion of patients' test preferences and did not facilitate shared decision-making. Patients' questions indicated their interest in different CRCS test types and appeared to elicit more information from physicians. Some patients remained resistant to CRCS after discussing it with a physician. Conclusion: If a preference for colonoscopy is widespread among primary-care physicians, the implications for intervention are either to prepare patients for this preference or to train physicians to offer options when recommending screening to patients.",
author = "Amy McQueen and Bartholomew, {L. Kay} and Greisinger, {Anthony J.} and Medina, {Gilda G.} and Hawley, {Sarah T.} and Paul Haidet and Bettencourt, {Judith L.} and Shokar, {Navkiran K.} and Ling, {Bruce S.} and Vernon, {Sally W.}",
year = "2009",
month = "11",
day = "1",
doi = "10.1007/s11606-009-1108-4",
language = "English (US)",
volume = "24",
pages = "1228--1235",
journal = "Journal of General Internal Medicine",
issn = "0884-8734",
publisher = "Springer New York",
number = "11",

}

McQueen, A, Bartholomew, LK, Greisinger, AJ, Medina, GG, Hawley, ST, Haidet, P, Bettencourt, JL, Shokar, NK, Ling, BS & Vernon, SW 2009, 'Behind closed doors: Physician-patient discussions about colorectal cancer screening', Journal of general internal medicine, vol. 24, no. 11, pp. 1228-1235. https://doi.org/10.1007/s11606-009-1108-4

Behind closed doors : Physician-patient discussions about colorectal cancer screening. / McQueen, Amy; Bartholomew, L. Kay; Greisinger, Anthony J.; Medina, Gilda G.; Hawley, Sarah T.; Haidet, Paul; Bettencourt, Judith L.; Shokar, Navkiran K.; Ling, Bruce S.; Vernon, Sally W.

In: Journal of general internal medicine, Vol. 24, No. 11, 01.11.2009, p. 1228-1235.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Behind closed doors

T2 - Physician-patient discussions about colorectal cancer screening

AU - McQueen, Amy

AU - Bartholomew, L. Kay

AU - Greisinger, Anthony J.

AU - Medina, Gilda G.

AU - Hawley, Sarah T.

AU - Haidet, Paul

AU - Bettencourt, Judith L.

AU - Shokar, Navkiran K.

AU - Ling, Bruce S.

AU - Vernon, Sally W.

PY - 2009/11/1

Y1 - 2009/11/1

N2 - Background: Despite the availability of multiple effective screening tests for colorectal cancer, screening rates remain suboptimal. The literature documents patient preferences for different test types and recommends a shared decision-making approach for physician-patient colorectal cancer screening (CRCS) discussions, but it is unknown whether such communication about CRCS preferences and options actually occurs in busy primary-care settings. Objective: Describe physician-patient CRCS discussions during a wellness visit. Design: Cross-sectional; patients audio-recorded with physicians. Participants: A subset of patients (N=64) participating in a behavioral intervention trial designed to increase CRCS who completed a wellness visit during the trial with a participating physician (N=8). Approach: Transcripts were analyzed using qualitative methods. Results: Physicians in this sample consistently recommended CRCS, but focused on colonoscopy. Physicians did not offer a fecal occult blood test alone as a screening choice, which may have created missed opportunities for some patients to get screened. In this single visit, physicians' communication processes generally precluded discussion of patients' test preferences and did not facilitate shared decision-making. Patients' questions indicated their interest in different CRCS test types and appeared to elicit more information from physicians. Some patients remained resistant to CRCS after discussing it with a physician. Conclusion: If a preference for colonoscopy is widespread among primary-care physicians, the implications for intervention are either to prepare patients for this preference or to train physicians to offer options when recommending screening to patients.

AB - Background: Despite the availability of multiple effective screening tests for colorectal cancer, screening rates remain suboptimal. The literature documents patient preferences for different test types and recommends a shared decision-making approach for physician-patient colorectal cancer screening (CRCS) discussions, but it is unknown whether such communication about CRCS preferences and options actually occurs in busy primary-care settings. Objective: Describe physician-patient CRCS discussions during a wellness visit. Design: Cross-sectional; patients audio-recorded with physicians. Participants: A subset of patients (N=64) participating in a behavioral intervention trial designed to increase CRCS who completed a wellness visit during the trial with a participating physician (N=8). Approach: Transcripts were analyzed using qualitative methods. Results: Physicians in this sample consistently recommended CRCS, but focused on colonoscopy. Physicians did not offer a fecal occult blood test alone as a screening choice, which may have created missed opportunities for some patients to get screened. In this single visit, physicians' communication processes generally precluded discussion of patients' test preferences and did not facilitate shared decision-making. Patients' questions indicated their interest in different CRCS test types and appeared to elicit more information from physicians. Some patients remained resistant to CRCS after discussing it with a physician. Conclusion: If a preference for colonoscopy is widespread among primary-care physicians, the implications for intervention are either to prepare patients for this preference or to train physicians to offer options when recommending screening to patients.

UR - http://www.scopus.com/inward/record.url?scp=70449518966&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=70449518966&partnerID=8YFLogxK

U2 - 10.1007/s11606-009-1108-4

DO - 10.1007/s11606-009-1108-4

M3 - Article

C2 - 19763699

AN - SCOPUS:70449518966

VL - 24

SP - 1228

EP - 1235

JO - Journal of General Internal Medicine

JF - Journal of General Internal Medicine

SN - 0884-8734

IS - 11

ER -