title: Patient willingness for repeat screening and preference for CT colonography and optical colonoscopy in ACRIN 6664: the National CT Colonography trial.
abstract: BACKGROUND
  Current American Cancer Society recommendations for colon cancer screening include optical colonoscopy every 10 years or computed tomography colonography (CTC) every 5 years. Bowel preparation (BP) is currently required for both screening modalities.
  
  
  OBJECTIVE
  To compare ACRIN 6664: the National CT Colonography Trial (NCTCT) participant experiences with CTC and optical colonoscopy (OC), procedure preference, and willingness to return for each procedure.
  
  
  METHODS
  Participants from fifteen NCTCT sites, who underwent CTC followed by OC under sedation, were invited to complete questionnaires 2 weeks postexam, asking about procedure preference, physical discomfort, and embarrassment experienced and whether that discomfort and embarrassment was better or worse than expected during BP, CTC, and OC, as well as willingness to return for repeat CTC and OC at different time intervals.
  
  
  RESULTS
  A total of 2,310 of 2,600 patients (89%) returned their questionnaires. Of patients reporting a preference, 1,058 (46.6%) preferred CTC, 569 (25.0%) preferred OC, and 626 (27.6%) reported no preference. Participant-reported discomfort worse than expected differed significantly between CTC (32.9%) and OC (5.0%) (P<0.001). About 79.3% were willing to be screened again with CTC in 5 years, and 96.6% with OC in 10 years. Discomfort and embarrassment worse than expected with OC were associated with increased intention to adhere with CTC in the future. Conversely, embarrassment experienced during CTC and discomfort worse than expected on CTC were associated with increased intention to adhere with OC in the future.
  
  
  CONCLUSIONS
  While a larger proportion of participants indicated that they preferred CTC to OC, willingness to undergo repeat CTC compared to OC was limited by unanticipated exam discomfort and embarrassment and CTC's shorter screening interval.
authors.affiliation: Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA ; Center for Statistical Sciences, Brown University School of Public Health, Providence, RI, USA.
authors.forename: Ilana F
authors.initials: IF
authors.lastname: Gareen
authors.affiliation: Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Bettina
authors.initials: B
authors.lastname: Siewert
authors.affiliation: Population Health Sciences, University of Wisconsin, Madison, WI, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Vanness
authors.affiliation: Center for Statistical Sciences, Brown University School of Public Health, Providence, RI, USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Herman
authors.affiliation: Mayo Clinic, Scottsdale, AZ, USA.
authors.forename: C D
authors.initials: CD
authors.lastname: Johnson
authors.affiliation: Center for Statistical Sciences, Brown University School of Public Health, Providence, RI, USA ; Department of Biostatistics, Brown University School of Public Health, Providence, RI, USA.
authors.forename: Constantine
authors.initials: C
authors.lastname: Gatsonis
keywords: CT colonography; adherence; bowel preparation; colonoscopy; patient preference