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Communication counts in improving colorectal cancer screening
Thomas Feeley’s study identifies reasons why patients were reluctant to get colorectal cancer screening despite their doctor’s recommendaton. Photo: DOUGLAS LEVERE
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“Any proper attempt to allay patient fears associated with colorectal cancer screening—or efforts to communicate the value of preventive medicine—require ample time for effective dialogue.”
Improved communication among patients and primary care physicians increases the chances that those who are due for colorectal cancer screening will follow their doctors’ advice and complete the procedure, a UB study has found.
The research by principal investigator Thomas H. Feeley, UB associate professor and a specialist in health communication, also found that the more convenient the screening process, the greater the chance patients would follow through and be tested for colon cancer. Feeley holds faculty appointments in communication, family medicine and nursing at UB. The study appears in the June issue of Health Communication.
“It became apparent during the study,” says Feeley, “that the communication related to cancer screening between health care provider and patient was positively related to an individual going through with the screening recommendation of the physician.”
Feeley’s research, based on 27 one-hour focus groups with patients, physicians, nurse practitioners and physicians’ assistants, found that lack of time, patient reluctance and difficulty in scheduling the test were reasons people ignored or failed to follow recommendations made by their primary care physician.
Indeed, physician recommendation and knowing someone who has or had cancer were the most common factors motivating patients’ decisions to complete colorectal cancer screening, the study concludes.
Most cases of colorectal cancer are detected at an advanced stage, when the chances the patient can recover decrease. The National Cancer Institute estimates that the five-year survival rate for colorectal cancer is about 70 percent. Screening patients with no symptoms of colorectal cancer for precancerous lesions greatly reduces the chances patients with these cancers will die from the disease. Although the test is quick, largely painless and not expensive, some studies estimate that fewer than 45 percent of the patients who should sign up for the test actually go through with the procedure.
The UB study identified a host of reasons why patients whose doctors had recommended they undergo this test avoided doing so. The reasons included fear of the test, embarrassment, fear of the results, the cost of the test and lack of time.
The study found several effective measures physicians can take to help their patients overcome the barriers and take the screening test: The more persistent doctors were in discussing colon cancer screening with patients, the more likely the patients would take the test. When the office personnel of primary care doctors scheduled the test for their patients, the “attrition levels” between the time the physician recommended the test and when these patients actually underwent the test decreased, according to patients’ testimony.
Furthermore, the vicarious experience of patients facing the screening test also influenced whether the patient would follow through with the test. “On the negative side,” Feeley explains. “many patients parroted reports from colleagues and friends about the horrors of the prep and embarrassment related to the colorectal screening. At the same time, many parents cited children and spouses as their inspiration to get screened; loved ones often tempered the negative response about screening presented in the break room or in the hallways at work.”
The words of physicians also had an impact on patients’ willingness to take the screening test. “One physician reported the use of analogies,” Feeley says. “For example, the physician said, ‘It is like taking care of your car; you must change the oil and check the engine to make sure all is going well.’”
But the study stressed this kind of physician-patient communication persuasive of the patient taking the screening test is hampered when the visits are rushed and distracted.
“Any proper attempt to allay patient fears associated with colorectal cancer screening—or efforts to communicate the value of preventive medicine—require ample time for effective dialogue,” Feeley says.
James Cooper and Martin C. Mahoney, both of Roswell Park Cancer Institute, and Thomas Foels of Independent Health Association were co-investigators on the study.
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