Talking to patients about screening colonoscopy—where conversations fall short
This mixed-methods study reveals 6 key points often neglected in physician-patient discussions.
Study limitations include simulated interaction
There were a number of limitations to this study. First, the investigators “simulated” the patient. Though study physicians were told to act as if they were speaking to a regular patient, they may still have unconsciously modified their usual approach to addressing this topic.
Second, we did not assess the effectiveness of these discussions in motivating actual patients to receive colonoscopy.
Other limitations included the following:
- We did not set a time period for these discussions, so they may have been even more limited in actual practice.
- We studied physicians from a single health care setting wherein colonoscopy appears to be the preferred approach to screen an average risk patient for colorectal cancer. In addition, in this health care system, this test is performed by a gastroenterologist, rather than a primary care physician.
- We did not determine whether patients regard our selected quotes as too colloquial or technical.
- This study did not address the important barrier of a physician forgetting to recommend colorectal cancer screening.35
Further research, next steps
Our study supports the hypothesis that physicians differ widely—but are generally deficient—when informing patients about screening colonoscopy. They generally emphasize the positives of colonoscopy and use terms that are colloquial, avoiding statistical concepts that may be hard for patients to understand. Future studies need to address the effectiveness of these approaches to discussing screening colonoscopy.
Given the central role of the primary care physician in motivating patients to undergo screening colonoscopy in a limited time period, it appears that additional supports are needed to supplement physician discussion about this important preventive care procedure.
Correspondence
Barbara J. Turner MD, MSEd, University of Pennsylvania, 1123 Blockley Hall/6021, 423 Guardian Drive, Philadelphia, PA 19104; bturner@mail.med.upenn.edu
