Partnering with patients in colon cancer screening decisions

By Anastasia Climan, RDN, CD-N | Fact-checked by Barbara Bekiesz
Published January 31, 2023

Key Takeaways

  • Patients resist undergoing colon cancer screenings for various reasons, including fear of pain, cost concerns, and not recognizing the procedure’s benefits.

  • Clinicians should explore such barriers and be open to alternative screening methods, to avoid pushing resistant patients further away.

  • Better pain management for colon cancer screenings can help improve the patient experience and promote compliance.

Clinicians understand the value of colon cancer screenings and early detection. But for a patient who is squeamish about medical procedures, worried about healthcare costs, or simply disinclined to go looking for problems they can’t feel, the motivation to get tested isn’t always there.

Here are three ways to get on the same page with your patients and earn their buy-in for potentially life-saving screenings.

1. Ask about your patient’s concerns

Patients have their reasons for being hesitant to schedule a colonoscopy or other colon cancer screening.

Some may be concerned about feeling pain, while others are scared to uncover bad news about their health. Some people may not want to take the time necessary for prep or request time off work to have a procedure. Paying for testing and finding transportation to and from appointments are also potential barriers.

It is not uncommon for patients to underestimate the need for colon cancer screening. After all, convincing any patient who feels healthy to undergo medical testing can be a challenge.

However, before you jump to conclusions about the underlying cause of your patients’ resistance, ask what’s holding them back. Let them guide the conversation so you can gain insight into their hesitancy and offer relevant support.

Patients who don’t feel heard or understood are more likely to shut down and stop responding to their physician’s requests.

Inviting patients to think about their reasons for refusal may get them to explore and address issues they didn’t realize they had.

2. Offer less-invasive alternatives

Many patients assume colonoscopies are the only way to screen for colon cancer. While colonoscopy can provide advantages over less invasive screenings, alternative methods are available, according to an article published by the American Society of Clinical Oncology (ASCO).[] Being open about the pros and cons of alternative tests keeps the door open and gives your patient the autonomy to make an informed decision.

For patients willing to do the prep but not undergo a full colonoscopy, for example, you can start by offering a sigmoidoscopy to examine the lower portion of the colon. Or for a full view of the colon that’s not invasive or painful, a virtual colonoscopy (CAT scan) by a radiologist may be an easier sell.

Stool testing can also screen for early colon cancer.

The fecal occult blood test and fecal immunochemical test are repeated annually to check for bloody stool as an indicator of tumors. Feces may also be examined for DNA changes associated with colon cancer.

You can also discuss doing a double-contrast barium enema (DCBE) to observe the colon and rectum using x-rays. However, patients should be made aware of the limitations of catching precancerous polyps with this method, according to the ASCO research.

Finally, there are non-invasive at-home colon cancer tests that analyze for abnormal DNA in stool samples that patients can collect in the comfort of their own home for .

If a patient decides that they want to start with less invasive testing, it is important for them to understand that a follow-up colonoscopy may be recommended, depending on the results and their other risk factors, as explained in an article published by the Mayo Clinic.[] Nonetheless, it’s better to keep patients engaged with some form of proactive colon cancer screening, even if their preferred test isn’t your top choice.

3. Discuss pain management

Don’t underestimate pain as a factor in a patient’s decision to avoid (or delay) medical testing.

Patients may have misconceptions about the level of sedation typically provided for colon cancer screenings, so reviewing expectations, fears, and past experiences is crucial.

In a cross-sectional analysis of 22,725 colonoscopy patients published by Gut, 22.5% of survey respondents who were not sedated reported pain during colonoscopies, and 14.2% said the pain continued after the procedure.[]

The use of benzodiazepine-opioid sedation slightly reduced the incidence of pain, to 19.9% during the procedure and 13.5% post-procedure. But the lowest accounts of pain were among patients who received propofol, with just 2.5% citing pain during the procedure and 7.5% afterward.

Talking to patients about their anticipation of pain during a colon cancer screening may help to ease their concerns and provide ways to make the experience less painful. As a result, clinicians can help reduce fear and encourage continued compliance with future screenings and medical care.

What this means for you

Patients may be reluctant to undergo screenings for colon cancer due to concerns about pain, cost, or the inconvenience associated with a procedure they feel is unnecessary. You can address these concerns—and perhaps overcome their resistance to screening—by discussing what’s holding them back, offering less-invasive alternatives such as stool testing, and explaining the different pain-management options. Being empathetic to your patients’ concerns could be very helpful in gaining their trust and their willingness to comply with your recommendations for screening.

Read Next: At-home colorectal screening: A convenient, noninvasive option
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