Transtheoretical Model (Stages of Change)

Decisional Balance and Colorectal Cancer Screening

Figure 4 is a sample decisional balance chart for CRC Screening.  Note that not all patients will think of all the items on this chart.  Some will have concerns or expectations that are not included here.  Decisional balance exercises can be particularly useful for patients who are hesitant to undergo screening.

Figure 4: The Benefits and Drawbacks 
of Having Regular Colorectal Cancer Screening

Benefits of Having 
Regular Screening
Drawbacks of Having 
Regular Screening
  • Every person is at risk of developing CRC.
  • It detects colorectal cancer early, before symptoms are noted.
  • When colorectal polyps or cancer are detected early there is a greater chance of cure.
  • Treatment is easier and can begin promptly when cancer is detected early.
  • Insurance companies pay a portion of the cost of CRC screening, as does Medicare.
  • Risk of complications is extremely low.
  • Can reduce the colorectal cancer death rate by 33%.
  • Endorsed by major health organizations.
  • Takes time.
  • Costs money.
  • May be uncomfortable-test or preparation.
  • Not foolproof - some polyps or cancers may be missed.
  • If something is found, treatment will be necessary which may cause discomfort
  • Rather not think about it or know if I have cancer.
  • I may not get colorectal cancer and therefore it’s not necessary.
  • May get biopsy unnecessarily.

Benefits of Not Having
Regular Screening
Drawbacks of Not Having 
Regular Screening
  • No discomfort from the procedure or preparation.
  • Can save money.
  • “What I don’t know won’t hurt me.”
  • Don’t have to travel and wait for procedure to be completed.
  • Time saved.
  • Don’t have to consider the chance of error.
  • Don’t have to find a qualified gastroenterologist.
  • Don’t have to follow through if something is found
  • Always wondering and worrying that “something” might be growing.
  • Poor role model for other family members.
  • Not assuming responsibility for own health maintenance.
  • Treatment options may not be as good.
  • Cancer can show up at any time - one FOBT, flexible sigmoidoscopy or colonoscopy is not sufficient.
  • Lose opportunity to find disease before there are symptoms.
  • Greater chance of death due to late stage of detection.
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Module II - Table of Contents
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