Conclusions

All average-risk patients age 50 or over should be screened for colorectal cancer.  Screening can prevent cancer through removal of pre-cancerous polyps and can reduce morbidity and mortality by allowing prompt treatment if cancer is present.  Patients at higher risk need earlier and/or more frequent screening, depending on the medical history.

Doctor-patient interactions provide multiple opportunities to steer patients toward screening and enhance compliance rates.  Behavioral science offers useful frameworks for increasing colorectal cancer screening.

• Health Belief Model.  Patient decisions are based on perceived seriousness of disease, ideas about personal susceptibility, perceived barriers vs. benefits, and personal confidence in ability to take action.


• Social Cognitive Theory.  Decisions are influenced by reciprocal interaction with the environment, including sense of personal control, observation of others’ behaviors, and expectations about outcomes.


• Stages of Change.  Decision-making proceeds along a continuum from pre-contemplation to action.  To be most effective, counseling should be tailored to the patient’s current stage.


• Precaution Adoption Model.  Taking precautions against a disease requires knowledge of the disease, impressions of general risk, and a conception of personal risk.


• Shared Decision-Making.  Interactive communication helps prevent clinicians from prescribing screening modalities with which individual patients are unlikely to comply. 

Both primary and secondary prevention of colorectal cancer are crucial to reduce colorectal cancer mortality.  By promoting screening, clinicians can have an enormously beneficial effect on their patients.  Discussing an individual's perception of his or her own colorectal cancer risk, thoughts about screening, and perceived benefits and barriers can favorably influence his or her decision to obtain regular colorectal cancer screening.