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Am Fam Physician. 1998;57(8):1945-1946

Patient preferences with respect to colorectal cancer screening have not been well studied. Dominitz and Provenzale evaluated patient preferences about colorectal screening using time trade-off issues as a measurement.

Four groups of patients were interviewed using a structured format that included time trade-off issues. Time trade-off has previously been shown to be a reliable tool for estimating the quality of life related to a variety of health states. The four groups consisted of 46 patients with colorectal cancer, 24 patients who were scheduled to undergo screening flexible sigmoidoscopy, 114 patients scheduled to undergo screening colonoscopy and 62 patients who had never undergone a colorectal cancer screening procedure. The interview covered quality-of-life issues concerning colorectal screening, current health status, colorectal cancer and colostomy.

The patients who had never undergone colorectal cancer screening were willing to trade off a median of 91 days of life expectancy to avoid a screening flexible sigmoidoscopy and a median of 183 days to avoid a colonoscopy. Patients in the other three groups were not willing to trade off any amount of life expectancy. Although 50 percent of the patients who had never undergone screening would have traded less than three months of life expectancy to avoid sigmoidoscopy every five years, 25 percent stated they would surrender a year or more of life expectancy to avoid sigmoidoscopy. Some of the patients had strong preferences for sedation during an endoscopic procedure, suggesting that colonoscopy may be appropriate in such patients. Other patients did not feel at ease with limiting the screening procedure to sigmoidoscopy.

The authors conclude that the majority of patients find endoscopy to be an acceptable procedure for colorectal cancer screening. However, some patients were willing to surrender more life expectancy to avoid these procedures. To address these issues, physicians must develop alternative strategies for patients whose preferences do not match the standard recommendations for colorectal cancer screening.

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