S241 Assessing How People Choose Between FIT and Colonoscopy: Does Knowing That a Positive FIT Requires a Follow-Up Colonoscopy Affect Decision Making?

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Introduction: In the US, FIT and colonoscopy are the most common screening modalities for colorectal cancer (CRC). While those with a + FIT need a follow-up colonoscopy, it is unclear whether this fact affects decision-making when people choose between FIT and colonoscopy at the outset. To address this gap, we administered two conjoint analysis surveys—one that explained the need for a follow-up colonoscopy after + FIT while the other did not—to a nationwide sample of Americans. We then assessed whether there were differences in colonoscopy/FIT preferences between the cohorts. Methods: Adults ≥40 years old who had not undergone CRC screening were recruited via an online survey research firm (Cint). To determine how people make tradeoffs when deciding among the CRC screening tests, we developed two surveys that used conjoint analysis (Figure 1). Survey 1 (4/2-4/15/21) did not inform participants that they need a colonoscopy following a + FIT while Survey 2 (4/29-6/2) informed respondents of the potential need (Figure 1). Using the conjoint analysis data, we determined the proportion of those who preferred FIT or colonoscopy; note: while the conjoint modeled five CRC tests, this study focused on comparing FIT vs colonoscopy. We then used logistic regression to assess for differences in colonoscopy/FIT preferences between the cohorts and to adjust for confounding. Results: Overall, 501 and 1,000 individuals completed Survey 1 (without description of need for colonoscopy after + FIT) and Survey 2 (with description), respectively. Demographics for the two cohorts are shown in the Table 1; save for slight differences in age, income, and comorbidities, the demographics between the groups were comparable. For Survey 1 (without description), 28.5% of individuals preferred colonoscopy while 71.5% preferred FIT. In Survey 2 (with description), the proportions were similar; 26.7% and 73.3% of respondents preferred colonoscopy and FIT, respectively. After adjusting for covariates (see Table 1) in the logistic regression, no statistical difference was seen in colonoscopy/FIT preferences between the cohorts (adjusted P = 0.09). Conclusion: Our study suggests that knowledge that a + FIT requires a follow-up colonoscopy does not affect people’s decision making when choosing between FIT or colonoscopy for CRC screening. As nearly three-quarters of individuals prefer FIT, it is vital to implement systems that ensure that those with a + FIT undergo timely colonoscopy.Figure 1.: Panel A: Sample conjoint exercise where participants consider three hypothetical CRC screening tests side by side and decide which one, if any, they would be most likely to do. Participants were shown a total of 9 vignettes. Panel B: Surveys 1 and 2 were the same except for Survey 2 including a statement that those with a positive stool test need to do a follow-up colonoscopy.Table 1.: Demographic comparisons between respondents who completed Surveys 1 and 2

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