Factors influencing colorectal cancer screening decision-making among average-risk US adults

Xuan Zhu, Emily Weiser, Joan M. Griffin, Paul J. Limburg, Lila J. Finney Rutten

Research output: Contribution to journalArticlepeer-review


Colorectal cancer (CRC) screening rates remain suboptimal in the US. We examined patient-focused concerns and influence of various factors (e.g., test attributes, provider recommendation) on CRC screening decision-making. We conducted a web survey with 1595 US adults aged 40–75 from a nationally representative panel in November 2019 (completion rate: 31.3 %). Analyses focused on individuals aged 45–75 years at average-risk for CRC (n = 1062). All participants rated their level of concern about various CRC screening test/procedure attributes. Participants who have screened previously designated the three most important attributes for choosing a screening method and rated how various factors influenced their decision to use a particular method. The top concern for participants who have not screened previously was having an invasive procedure (54.2 %) while the top concerns for participants who have screened previously were completing a colon prep (41.3 %) and test/procedure accuracy (41 %). Cost/insurance coverage was most frequently ranked among the most important attributes (48.5 %), followed by where the test can be taken (45.7 %) and test accuracy (43.6 %). Provider recommendation was reported as the major motivator across screening methods. Other factors that were frequently reported as very influential included convenience and comfort for the stool-based methods and scientific/clinical evidence and insurance coverage for colonoscopy. Variations by age, sex, and race/ethnicity were noted. Findings demonstrate that along with provider recommendation, patient preferences regarding test/procedure attributes and preparation requirements are influential in screening decision-making, highlighting the need for clinicians to involve patients in shared decision-making and incorporate patient needs and preferences in establishing screening strategies.

Original languageEnglish (US)
Article number102047
JournalPreventive Medicine Reports
StatePublished - Dec 2022


  • Colonoscopy
  • Colorectal cancer screening
  • Fecal immunochemical test/guaiac-based fecal occult blood test
  • Multi-target stool DNA
  • Patient decision-making

ASJC Scopus subject areas

  • Epidemiology
  • Public Health, Environmental and Occupational Health


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