The success of current colorectal cancer prevention efforts depends on screening. In 2000, however, fewer than half of the average risk patients in the United States were in compliance with screening recommendations. Additional research to help overcome barriers to screening has been recognized as an important step toward meeting national colorectal cancer prevention goals. Current screening guidelines for average risk patients endorse 5 options: annual fecal occult blood tests, flexible sigmoidoscopy every 5 years, combined annual fecal occult blood tests and flexible sigmoidoscopy every 5 years, double contrast barium enema every 5 years, and colonoscopy every 10 years. Patients and physicians are encouraged to compare the options' pros and cons and select the one best suited for individual patient preferences and circumstances. A common element of several theories of health behavior is that a person's attitude toward a proposed intervention affects their behavior and that attitudes are directly influenced by an intervention's perceived risks and benefits. This raises the hypothesis that information about how primary care decision makers view the risks and benefits of colorectal cancer screening tests will help identify and overcome screening barriers. We will use the Analytic Hierarchy Process (AHP), a multi-criteria decision making method, to examine how 650 average risk patients and their primary care physicians view the trade-offs between the advantages and disadvantages of the 5 currently recommended colorectal screening options. The patients and physicians will be from diverse primary care settings in Rochester NY, Birmingham AL, Indianapolis IN, and the Alabama practice-based CME network. The data will be analyzed using descriptive and multivariable analysis to address 5 specific aims: 1) to describe the range of priorities average risk patients assign to decision criteria that describe strengths and weaknesses of the five currently recommended colorectal cancer screening options; 2) to describe the range of priorities primary care physicians assign to the same decision criteria when making screening recommendations for study patients; 3) to see if patient or physician decision priorities are associated with patient or physician specific factors ; 4) to compare patient and physician priorities; and 5) to determine subsequent colorectal cancer screening outcomes and the validity and acceptability of an AHP-based decision priority assessment.
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