Ketchup or mustard? Fecal occult blood test or colonoscopy?

Take your choice - Photo by flickr user greenkozi

Given an ultimatum—you will eat a hamburger—kids will often rebel.

Given a choice—hamburger or chicken nuggets—kids will usually comply.

At the annual Digestive Disease Week, researchers have found the same principle applies to patients when it’s time for a colorectal cancer screening.

Dr. John Inadomi, of the University of California, San Francisco, conducted the fascinating study, which randomized 1,000 patients to one of three screening recommendations: fecal occult blood test, colonoscopy, or their choice between the two.

Significantly more patients who were offered FOBT actually got the test (67%), compared to those offered colonoscopy (38%). Not surprising, given the trepidation with which most first-timers view colonoscopy.

But when given the choice between the two, almost 71% followed through with a screening, significantly more than in either of groups where one specific screening was recommended.

The study didn’t discuss the relative merits of either test, or which patients might benefit more from colonoscopy than FOBT. But it does speak volumes to the importance of allowing patients to be partners in their health care, rather than counting on unquestioning obedience to physician dictum.

The study looked at other aspects of patient empowerment as well. The population reflected the diverse San Francisco community where it was performed: 30% Latino, 30% Asian, 18% black, and 15% white. Most research finds that minority and inner city populations tend to have poor health care utilization. But in this study, the investigators tried to maximize screening adherence by removing as many barriers as possible, offering rides to screening, reducing or eliminating the cost, and giving instructions in the patient’s native language. The high overall rate of screening (67%) reflected how people embrace health care when they have the power to do so

“In a system where access is provided and language is not a barrier, we see that immigrants have the tools to access the health care system in the same way they would in their own country,” Dr. Inodami said.

—Michele G. Sullivan (@MGSullivan on Twitter)
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Filed under Family Medicine, Gastroenterology, IMNG, Internal Medicine, Primary care, Uncategorized

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