Physician colorectal cancer screening recommendations: An examination based on informed decision making

Sarah B. Wackerbarth, Yelena N. Tarasenko, Jennifer M. Joyce, Steven A. Haist

Research output: Contribution to journalArticlepeer-review

33 Scopus citations


Objective: The purpose of this research was to examine the content of physicians' colorectal cancer screening recommendations. More specifically, using the framework of informed decision making synthesized by Braddock and colleagues, we conducted a qualitative study of the content of recommendations to describe how physicians are currently presenting this information to patients. Methods: We conducted semi-structured interviews with 65 primary care physicians. We analyzed responses to a question designed to elicit how the physicians typically communicate their recommendation. Results: Almost all of the physicians (98.5%) addressed the "nature of decision" element. A majority of physicians discussed "uncertainties associated with the decision" (67.7%). Fewer physicians covered "the patient's role in decision making" (33.8%), "risks and benefits" (16.9%), "alternatives" (10.8%), "assessment of patient understanding" (6.2%), or "exploration of patient's preferences" (1.5%). Conclusion: We propose that the content of the colorectal screening recommendation is a critical determinant to whether a patient undergoes screening. Our examination of physician recommendations yielded mixed results, and the deficiencies identified opportunities for improvement. Practice implications: We suggest primary care physicians clarify that screening is meant for those who are asymptotic, present tangible and intangible benefits and risks, as well as make a primary recommendation, and, if needed, a "compromise" recommendation, in order to increase screening utilization.

Original languageEnglish
Pages (from-to)43-50
Number of pages8
JournalPatient Education and Counseling
Issue number1
StatePublished - Apr 2007

Bibliographical note

Funding Information:
I confirm all personal identifiers have been removed so that persons described are not identifiable and cannot be identified through the details of the story. The National Cancer Institute (R21CA102349 to SBW) and the Agency for Healthcare Research and Quality (R24HS01184503) supported this work. The project was approved by the University of Kentucky Institutional Review Board (#03-0079-P1B). We acknowledge and thank Mark Eckman, MD, and Mary Barron, RN, for assistance with recruitment, Jane Peters, Ph.D., and April Morgan, MA, for conducting interviews, Manu Mooker for her role on the analysis team, and Michael Doukas, MD, and Margaret Love, Ph.D., and Brian Stevenson, Ph.D., for consultation. Last, but not least, we wish to thank our interview participants.


  • Colorectal cancer
  • Decision making
  • Patient-provider interaction
  • Preventive care
  • Qualitative methods
  • Screening

ASJC Scopus subject areas

  • General Medicine


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