title: Is discussion of colorectal cancer screening options associated with heightened patient confusion?
abstract: BACKGROUND
  Clinical guidelines recommend offering patients options for colorectal cancer (CRC) screening, but the modalities vary by frequency, accuracy, preparations, discomfort, and cost, which may cause confusion and reduce screening rates. We examined whether patients reported confusion about the options and whether confusion was associated with socio-demographic characteristics, number of options discussed, and adherence.
  
  
  METHODS
  Patients ages 50 to 75 years who had visited a clinician within 2 years were randomly selected for a cross-sectional study (n = 6,100). A questionnaire mailed in 2007 asked the following: whether a clinician had ever discussed CRC screening options; which of four recommended tests (i.e., fecal occult blood testing, flexible sigmoidoscopy, colonoscopy, and barium enema) were presented; and whether the options were confusing. Analyses were restricted to respondents who reported discussing one or more screening options (n = 1,707). Weighted frequencies were calculated and multivariate logistic regression was done.
  
  
  RESULTS
  The sample was 55.5% female, 15.6% African American, and 83.2% adherent to screening recommendations, and 56.0% had discussed two or more screening options. In adjusted analyses, nonadherent patients reported greater confusion than adherent patients (P < 0.01). Adults who discussed two or more options were 1.6 times more likely to be confused than those who discussed one option [95% confidence interval (CI), 1.08-2.26]. Patients who reported being confused were 1.8 times more likely to be nonadherent to screening than those who did not (95% CI, 1.14-2.75).
  
  
  CONCLUSIONS
  Our study provides the first empirical evidence linking multiple options with confusion and confusion with screening adherence.
  
  
  CONCLUSIONS
  Confusion may act as a barrier to screening and should be considered in public health messages and interventions.
authors.affiliation: Department of Epidemiology and Community Health, Virginia Commonwealth University, Richmond, VA 23298-0212, USA. rmjones2@vcu.edu
authors.forename: Resa M
authors.initials: RM
authors.lastname: Jones
authors.forename: Sally W
authors.initials: SW
authors.lastname: Vernon
authors.forename: Steven H
authors.initials: SH
authors.lastname: Woolf
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000517:prevention & control*; D003221:Confusion; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology*; D011795:Surveys and Questionnaires