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.
  
  
  METHODS
  Cross-sectional; patients audio-recorded with physicians.
  
  
  METHODS
  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).
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Health Behavior Research, Washington University, School of Medicine, 4444 Forest Park Ave., St Louis, MO 63108, USA. amcqueen@dom.wustl.edu
authors.forename: Amy
authors.initials: A
authors.lastname: McQueen
authors.forename: L Kay
authors.initials: LK
authors.lastname: Bartholomew
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Greisinger
authors.forename: Gilda G
authors.initials: GG
authors.lastname: Medina
authors.forename: Sarah T
authors.initials: ST
authors.lastname: Hawley
authors.forename: Paul
authors.initials: P
authors.lastname: Haidet
authors.forename: Judith L
authors.initials: JL
authors.lastname: Bettencourt
authors.forename: Navkiran K
authors.initials: NK
authors.lastname: Shokar
authors.forename: Bruce S
authors.initials: BS
authors.lastname: Ling
authors.forename: Sally W
authors.initials: SW
authors.lastname: Vernon
mesh_terms: D000368:Aged; D003113:Colonoscopy / Q000379:methods; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D010353:Patient Education as Topic / Q000379:methods*; D010817:Physician-Patient Relations