title: Patient and Provider Preferences for Colorectal Cancer Screening: How Does CT Colonography Compare to Other Modalities?
abstract: OBJECTIVE
  Patient and provider preferences toward CT colonography (CTC) remain unclear. The primary goals of this study were 1) to investigate patient preferences for one of the currently recommended CRC screening modalities and 2) to evaluate provider preferences before and after review of updated guidelines.
  
  
  METHODS
  Cross-sectional survey of ambulatory-care patients and providers in the primary care setting. Providers were surveyed before and after reviewing the 2008 guidelines by the American Cancer Society, US Multisociety Task Force on Colorectal Cancer and the American College of Radiology.
  
  
  RESULTS
  Of 100 patients surveyed, 59% preferred colonoscopy, 17% fecal occult blood testing (FOBT), 14% stool DNA (sDNA) testing, and 10% CTC (P<0.001). The majority of those whose first choice was a stool-based test chose the alternate stool-based test as their second choice over CTC or colonoscopy (P<0.0001). Patients who preferred colonoscopy chose accuracy (76%) and frequency of testing (10%) as the most important test features, whereas patients who preferred a stool-based test chose discomfort (52%) and complications (23%). Of 170 providers surveyed, 96% chose colonoscopy, 2% FOBT, and 1% FOBT with flexible sigmoidoscopy (FS) (p < 0.0001). No providers chose CTC or sDNA as their preferred option before reviewing guidelines, and 89% kept their preference after review of guidelines. As a default option for patients who declined colonoscopy, 44% of providers chose FOBT, 12% FOBT+FS, 4% CTC, and 37% deferred to patient preference before review of guidelines. Of the 33% of providers who changed their preference after review of guidelines, 46% recommended CTC. Accuracy was the most influential reason for provider test choice.
  
  
  CONCLUSIONS
  Patients and providers prefer colonoscopy for CRC screening. Revised guidelines endorsing the use of CTC are unlikely to change provider preferences but may influence choice of default strategies for patients who decline colonoscopy.
authors.affiliation: Boston University School of Medicine, Department of Medicine, Section of Gastroenterology, Boston, MA.
authors.forename: Audrey H
authors.initials: AH
authors.lastname: Calderwood
authors.affiliation: Boston University School of Medicine, Department of Medicine, Section of Gastroenterology, Boston, MA.
authors.forename: Sharmeel K
authors.initials: SK
authors.lastname: Wasan
authors.affiliation: Boston University School of Public Health, Department of Biostatistics, Boston, MA.
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Heeren
authors.affiliation: Boston University School of Medicine, Department of Medicine, Section of Gastroenterology, Boston, MA.
authors.forename: Paul C
authors.initials: PC
authors.lastname: Schroy