P0248 - Assessing How People Choose Between FIT and Colonoscopy: Does Knowing That a Positive FIT Requires a Follow-Up Colonoscopy Affect Decision Making?

Jaspreet Shergill, MD, MS¹, Katherine Makaroff, BA², Marie Lauzon, MS¹, Brennan Spiegel, MD, MSHS¹, Christopher V. Almario, MD, MSHPM, FACG^1
1Cedars-Sinai Medical Center, Los Angeles, CA; ²Cedars-Sinai Center for Outcomes Research and Education, Los Angeles, CA

Introduction: In the US, FIT and colonoscopy are the most common screening modalities for colorectal cancer (CRC). While those with a +FIT need a follow-up colonoscopy, it is unclear whether this fact affects decision-making when people choose between FIT and colonoscopy at the outset. To address this gap, we administered two conjoint analysis surveys—one that explained the need for a follow-up colonoscopy after +FIT while the other did not—to a nationwide sample of Americans. We then assessed whether there were differences in colonoscopy/FIT preferences between the cohorts.

Methods: Adults ≥40 years old who had not undergone CRC screening were recruited via an online survey research firm (Cint). To determine how people make tradeoffs when deciding among the CRC screening tests, we developed two surveys that used conjoint analysis (Figure). Survey 1 (4/2-4/15/21) did not inform participants that they need a colonoscopy following a +FIT while Survey 2 (4/29-6/2) informed respondents of the potential need (Figure). Using the conjoint analysis data, we determined the proportion of those who preferred FIT or colonoscopy; note: while the conjoint modeled five CRC tests, this study focused on comparing FIT vs. colonoscopy. We then used logistic regression to assess for differences in colonoscopy/FIT preferences between the cohorts and to adjust for confounding.

Results: Overall, 501 and 1,000 individuals completed Survey 1 (without description of need for colonoscopy after +FIT) and Survey 2 (with description), respectively. Demographics for the two cohorts are shown in the Table; save for slight differences in age, income, and comorbidities, the demographics between the groups were comparable. For Survey 1 (without description), 28.5% of individuals preferred colonoscopy while 71.5% preferred FIT. In Survey 2 (with description), the proportions were similar; 26.7% and 73.3% of respondents preferred colonoscopy and FIT, respectively. After adjusting for covariates (see Table) in the logistic regression, no statistical difference was seen in colonoscopy/FIT preferences between the cohorts (adjusted p=0.09).

Discussion: Our study suggests that knowledge that a +FIT requires a follow-up colonoscopy does not affect people’s decision making when choosing between FIT or colonoscopy for CRC screening. As nearly three-quarters of individuals prefer FIT, it is vital to implement systems that ensure that those with a +FIT undergo timely colonoscopy.


Figure: FIGURE. Panel A: Sample conjoint exercise where participants consider three hypothetical CRC screening tests side by side and decide which one, if any, they would be most likely to do. Participants were shown a total of 9 vignettes. Panel B: Surveys 1 and 2 were the same except for Survey 2 including a statement that those with a positive stool test need to do a follow-up colonoscopy.

Variable	Survey 1 (n=501)	Survey 2 (n=1,000)	P-value
Age:
40-49 yo	194 (38.7)	456 (45.6)	0.04
50-59 yo	146 (29.1)	267 (26.7)
≥60 yo	161 (32.1)	277 (27.7)
Sex:
Male	256 (51.1)	487 (48.7)	0.59
Female	244 (48.7)	512 (50.4)
Prefer not to Say	1 (0.2)	1 (0.1)
Race/Ethnicity:
Non-Hispanic White	389 (77.6)	806 (80.6)	0.33
Non-Hispanic Black	27 (5.4)	64 (6.4)
Latinx	37 (7.4)	57 (5.7)
Non-Hispanic Asian	26 (5.2)	41 (4.1)
Other	22 (4.4)	32 (3.2)
Educational Attainment:
High School Degree or Less	140 (27.9)	281 (28.1)	0.94
Some College Education	128 (25.6)	248 (24.8)
College Degree	167 (33.3)	347 (34.7)
Graduate Degree	66 (13.2)	124 (12.4)
Marital Status:
Married or Living with Partner	266 (53.1)	529 (52.9)	0.94
Not Married	235 (46.9)	471 (47.1)
Total Household Income,$:
< 50,000	244 (48.7)	517 (51.7)	0.006
50,000-100,000	146 (29.1)	298 (29.8)
≥100,001	81 (16.2)	161 (16.1)
Prefer not to say	30 (6.0)	24 (2.4)
Employment Status:
Unemployed, on disability, on leave of absence from work, retired or a homemaker	249 (49.7)	471 (47.1)	0.34
Employed or Student	252 (50.3)	529 (52.9)
Insurance Plan:
Has Insurance Plan	418 (83.4)	845 (84.5)	0.59
No Insurance	83 (16.6)	155 (15.5)
Has usual source of care (USOC):
Has USOC	379 (75.7)	800 (80.0)	0.05
No USOC	122 (24.4)	200 (20.0)
Self-reported health status:
Excellent	57 (11.4)	88 (8.8)	0.45
Very good	130 (25.9)	280 (28.0)
Good	210 (41.9)	407 (0.7)
Fair	91 (18.2)	192 (19.2)
Poor	13 (2.6)	33 (3.3)
Number of Medical Comorbidities:
0	156 (31.1)	252 (25.2)	0.02
1	124 (24.8)	225 (2.5)
2	84 (16.8)	211 (21.1)
≥3	137 (27.4)	312 (31.2)
Number of GI Comorbidities:
0	412 (82.2)	760 (76.0)	0.04
1	62 (12.4)	170 (17.0)
2	18 (3.6)	54 (5.4)
≥3	9 (1.8)	16 (1.6)
Number of GI symptoms experienced in past 3 months:
0	279 (55.7)	479 (47.9)	0.04
1	87 (17.4)	202 (20.2)
2	61 (12.2)	133 (13.3)
≥3	74 (14.8)	186 (18.6)
U.S region:
Northeast	89 (17.8)	225 (22.5)	0.15
South	174 (34.7)	344 (34.4)
Midwest	119 (23.8)	207 (20.7)
West	119 (23.8	224 (22.4)
Has non-first degree relative or friend diagnosed with CRC:
No/not sure	442 (88.2)	862 (86.2)	0.27
Yes	59 (11.8)	138 (13.8)
Plans to get screened for CRC:
Disagree/strongly disagree	258 (51.5)	481 (48.1)	0.21
Agree/strongly agree	243 (48.5)	519 (51.9)

Table: TABLE. Demographic comparisons between respondents who completed Surveys 1 and 2.
FOOTNOTE: Data are presented as n (% of column). The chi-squared test was used to compare categorical data.


Disclosures:
Jaspreet Shergill indicated no relevant financial relationships.
Katherine Makaroff indicated no relevant financial relationships.
Marie Lauzon indicated no relevant financial relationships.
Brennan Spiegel indicated no relevant financial relationships.
Christopher Almario indicated no relevant financial relationships.


Jaspreet Shergill, MD, MS¹, Katherine Makaroff, BA², Marie Lauzon, MS¹, Brennan Spiegel, MD, MSHS¹, Christopher V. Almario, MD, MSHPM, FACG¹. P0248 - Assessing How People Choose Between FIT and Colonoscopy: Does Knowing That a Positive FIT Requires a Follow-Up Colonoscopy Affect Decision Making?, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.