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 Researchers focused on two widely used screenings. One, a process
known as fecal occult blood testing (FOBT), looks for blood – a
possible sign of cancer - in stool samples once a year. The other, a
colonoscopy exam that snakes a tiny camera through the rectum to
view the colon, searches for abnormal growths once a decade.
About 1,000 patients were divided into three groups and randomly
assigned to get either FOBT or colonoscopy, or given a choice
between the two options.
Over three years, 42 percent of participants given a choice between
the tests followed through with screening and 38 percent of people
assigned to get colonoscopies did so. Just 14 percent of the
patients assigned to FOBT got the test done each year.
In the choice group, there was also a steep drop off in FOBT after
the first year among people who had opted for that method.
“Fecal occult blood testing needs to be repeated every year to have
the same protective effect as getting a colonoscopy every 10 years,”
said lead study Dr. Peter Liang of the University of Washington in
Seattle. “Allowing people to choose their screening test and using
patient navigators to help them get their tests completed will
increase the overall adherence to colorectal cancer screening.”
To help increase the odds that patients got recommended screenings,
members of the research team served as patient navigators during the
first year of the study. In this role, they described the screening
process to patients, helped schedule tests, explained bowel
preparations for testing and helped arrange transportation home
after colonoscopies.
Study participants were identified from the San Francisco Community
Health Network, a safety net public health system, and there were
research team members fluent in English, Spanish, Cantonese and
Mandarin.
People who were homosexual, married or in serious relationships were
more likely to comply with screenings, as were Chinese speakers, the
study found.
Patients who were assigned to colonoscopy or chose this option were
considered non-compliant if they failed to get the test within the
first year of the study.
Participants who were assigned to FOBT or chose this alternative
were counted as non-compliant if they didn’t do the test annually
during the three-year study, if they did the tests but submitted
stool samples incorrectly, or if they failed to follow up with a
recommended colonoscopy based on the results.
When researchers looked at whether patients could follow through
with FOBT every other year instead of annually, compliance was 40
percent for the FOBT group, 51 percent in the colonoscopy group and
56 percent for the group given a choice between the two options.
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U.S. guidelines recommend FOBT every year, but screening programs in
Canada and Europe use biannual testing, Liang and colleagues note in
the American Journal of Gastroenterology.
The study wasn’t designed to assess the effectiveness of patient
navigators, but one shortcoming of the research was that the
withdrawal of this support after the first year might have
contributed to lower rates of FOBT compliance, the authors point
out.
Even so, the findings highlight the importance of giving patients a
say in what type of screening they get, said Dr. Samir Gupta, a
researcher at the University of California, San Diego, who wasn’t
involved in the study.
“Our suspicion is that patients selecting colonoscopy often do so
because they value its high sensitivity for polyps and cancer, and
don’t mind the invasiveness and inconvenience, and that patients
selecting stool blood tests often do so because the test is more
convenient,” Gupta said by email.
While previous research has found lower screening rates in some
minority groups, the study findings suggest that language barriers
can be overcome with patient navigators, said Dr. David Lieberman of
Oregon Health and Science University in Portland.
“Suggesting that the patient perform an `unpleasant’ test when they
have no symptoms requires a strong educational component,”
Lieberman, who wasn’t involved in the study, said by email.
SOURCE: http://bit.ly/1OGLxVd American Journal of Gastroenterology,
online November 3, 2015.
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