title: Informed choice vs. no choice in colorectal cancer screening tests: a prospective cohort study in real-life screening practice.
abstract: OBJECTIVE
  The objective of this study was to compare the level of adherence to colorectal cancer (CRC) screening programs among screening participants offered vs. not offered informed choices on screening modality.
  
  
  METHODS
  We recruited 10,606 screening participants aged 50-70 years, including 6,397 subjects who were offered a choice of yearly fecal immunochemical test (FIT) for up to 3 years vs. one colonoscopy, and 4,209 subjects who were offered either FIT or colonoscopy without choice. They were prospectively followed up for 3 years. The proportion of screening participants who returned their specimens in all subsequent years (FIT group) and the attendance rate of scheduled endoscopy appointment (colonoscopy group) were compared between those with vs. without choice.
  
  
  RESULTS
  The adherence rate with FIT was 97.6%, 84.1%, and 72.6% in the first 3 years of follow-up, respectively, among those who were offered a choice. The adherence rate with FIT was 97.5%, 78.4%, and 62.8%, respectively, among those without choices. The proportion of subjects attending colonoscopy was 95.7% (choice offered) and 90.6% (no choice). From binary logistic regression analysis, participants who were offered informed choice were significantly more likely to adhere to the program when compared with those without test choices (odds ratio (OR)=2.54, 95% confidence interval (CI): 2.30-2.82, P<0.001). The respective adjusted OR for the FIT and colonoscopy groups was 1.60 (95% CI: 1.42-1.80, P<0.001) and 2.53 (95% CI: 1.94-3.31, P<0.001).
  
  
  CONCLUSIONS
  This study found that patients who were offered an informed choice for screening had higher adherence rates than patients who were not offered a choice in real-life practices, suggesting that providing screening test options for CRC screening is preferred.
authors.affiliation: 1] Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong, China [2] School of Public Health and Primary Care, Chinese University of Hong Kong, Shatin, Hong Kong, China.
authors.forename: Martin C S
authors.initials: MC
authors.lastname: Wong
authors.affiliation: Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong, China.
authors.forename: Jessica Y L
authors.initials: JY
authors.lastname: Ching
authors.affiliation: Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong, China.
authors.forename: Victor C W
authors.initials: VC
authors.lastname: Chan
authors.affiliation: Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong, China.
authors.forename: Thomas Y T
authors.initials: TY
authors.lastname: Lam
authors.affiliation: Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong, China.
authors.forename: Arthur K C
authors.initials: AK
authors.lastname: Luk
authors.affiliation: Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong, China.
authors.forename: Siew C
authors.initials: SC
authors.lastname: Ng
authors.affiliation: Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong, China.
authors.forename: Simon S M
authors.initials: SS
authors.lastname: Ng
authors.affiliation: Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong, China.
authors.forename: Joseph J Y
authors.initials: JJ
authors.lastname: Sung
mesh_terms: D000368:Aged; D002755:Choice Behavior; D003113:Colonoscopy / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D006723:Hong Kong; D006801:Humans; D007258:Informed Consent; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010349:Patient Compliance; D011446:Prospective Studies