Baseline Features and Reasons for Nonparticipation in the Colonoscopy Versus Fecal Immunochemical Test in Reducing Mortality From Colorectal Cancer (CONFIRM) Study, a Colorectal Cancer Screening Trial Article Swipe

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Douglas J. Robertson , Jason A. Dominitz , Alexander Beed , Kathy D. Boardman , Barbara J. Del Curto , Peter Guarino , Thomas F. Imperiale , Andrew J. LaCasse , Meaghan F. Larson , Samir Gupta , David A. Lieberman , Beata Planeta , Aasma Shaukat , Shahnaz Sultan , Stacy B. Menees , Sameer D. Saini , Philip Schoenfeld , Stephan U. Goebel , Erik C. von Rosenvinge , György Baffy , Ildiko Halasz , Marcos Pedrosa , Lyn Sue Kahng , Riaz Cassim , Katarina B. Greer , Margaret Kinnard , Divya Bhatt , Kerry B. Dunbar , William V. Harford , John A. Mengshol , Jed Olson , Swati Patel , Fadi Antaki , Deborah A. Fisher , Brian A. Sullivan , Christopher Lenza , Devang Prajapati , Helen Wong , Rebecca J. Beyth , John Lieb , Joseph Manlolo , Fernando V. Ona , Rhonda A. Cole , Natalia Khalaf , Charles J. Kahi , Divyanshoo R. Kohli , Tarun Rai , Prateek Sharma , Jiannis Anastasiou , Curt H. Hagedorn , Ronald Fernando , Christian S. Jackson , M. Mazen Jamal , Robert H. Lee , Farrukh H. Merchant , Folasade P. May , Joseph R. Pisegna , Endashaw Omer , Dipendra Parajuli , Adnan Said , Toan D. Nguyen , Claudio Tombazzi , P. A. Feldman , Leslie Jacob , Rachel Koppelman , Kyle P. Lehenbauer , Deepak Desai , Mohammad F. Madhoun , William M. Tierney , Minh Q. Ho , H Hockman , Christopher D. Lopez , Emily Carter Paulson , Martin Tobi , Hugo Pinillos , Michele Young , Nancy Ho , Ranjan Mascarenhas , K. Promrat , Pritesh Mutha , William M. Pandak , Tilak Shah , Mitchell L. Schubert , Frank S. Pancotto , Andrew J. Gawron , Amelia E. Underwood , Samuel B. Ho , Priscilla Magno-Pagatzaurtundua , Doris H. Toro , Charles Beymer , Andrew M. Kaz , Jill E. Elwing , Jeffrey Gill , Susan F. Goldsmith , Michael Yao , Petr Protiva , Heiko Pohl , Tassos C. Kyriakides , Elaine Kleiner , Kathy Sullivan ·

YOU? · · 2023 · Open Access · · DOI: https://doi.org/10.1001/jamanetworkopen.2023.21730

Importance The Colonoscopy Versus Fecal Immunochemical Test in Reducing Mortality From Colorectal Cancer (CONFIRM) randomized clinical trial sought to recruit 50 000 adults into a study comparing colorectal cancer (CRC) mortality outcomes after randomization to either an annual fecal immunochemical test (FIT) or colonoscopy. Objective To (1) describe study participant characteristics and (2) examine who declined participation because of a preference for colonoscopy or stool testing (ie, fecal occult blood test [FOBT]/FIT) and assess that preference’s association with geographic and temporal factors. Design, Setting, and Participants This cross-sectional study within CONFIRM, which completed enrollment through 46 Department of Veterans Affairs medical centers between May 22, 2012, and December 1, 2017, with follow-up planned through 2028, comprised veterans aged 50 to 75 years with an average CRC risk and due for screening. Data were analyzed between March 7 and December 5, 2022. Exposure Case report forms were used to capture enrolled participant data and reasons for declining participation among otherwise eligible individuals. Main Outcomes and Measures Descriptive statistics were used to characterize the cohort overall and by intervention. Among individuals declining participation, logistic regression was used to compare preference for FOBT/FIT or colonoscopy by recruitment region and year. Results A total of 50 126 participants were recruited (mean [SD] age, 59.1 [6.9] years; 46 618 [93.0%] male and 3508 [7.0%] female). The cohort was racially and ethnically diverse, with 748 (1.5%) identifying as Asian, 12 021 (24.0%) as Black, 415 (0.8%) as Native American or Alaska Native, 34 629 (69.1%) as White, and 1877 (3.7%) as other race, including multiracial; and 5734 (11.4%) as having Hispanic ethnicity. Of the 11 109 eligible individuals who declined participation (18.0%), 4824 (43.4%) declined due to a stated preference for a specific screening test, with FOBT/FIT being the most preferred method (2820 [58.5%]) vs colonoscopy (1958 [40.6%]; P < .001) or other screening tests (46 [1.0%] P < .001). Preference for FOBT/FIT was strongest in the West (963 of 1472 [65.4%]) and modest elsewhere, ranging from 199 of 371 (53.6%) in the Northeast to 884 of 1543 (57.3%) in the Midwest ( P = .001). Adjusting for region, the preference for FOBT/FIT increased by 19% per recruitment year (odds ratio, 1.19; 95% CI, 1.14-1.25). Conclusions and Relevance In this cross-sectional analysis of veterans choosing nonenrollment in the CONFIRM study, those who declined participation more often preferred FOBT or FIT over colonoscopy. This preference increased over time and was strongest in the western US and may provide insight into trends in CRC screening preferences.

Related Topics

Colonoscopy

Medicine

Fecal Occult Blood

Descriptive Statistics

Randomized Controlled Trial

Concepts

Colonoscopy Medicine Colorectal cancer Fecal occult blood Veterans Affairs Logistic regression Descriptive statistics Cohort Randomized controlled trial Randomization Cancer Internal medicine Demography Statistics Mathematics Sociology

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Landing Page: https://doi.org/10.1001/jamanetworkopen.2023.21730
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Title: Baseline Features and Reasons for Nonparticipation in the Colonoscopy Versus Fecal Immunochemical Test in Reducing Mortality From Colorectal Cancer (CONFIRM) Study, a Colorectal Cancer Screening Trial

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Authors: Douglas J. Robertson, Jason A. Dominitz, Alexander Beed, Kathy D. Boardman, Barbara J. Del Curto, Peter Guarino, Thomas F. Imperiale, Andrew J. LaCasse, Meaghan F. Larson, Samir Gupta, David A. Lieberman, Beata Planeta, Aasma Shaukat, Shahnaz Sultan, Stacy B. Menees, Sameer D. Saini, Philip Schoenfeld, Stephan U. Goebel, Erik C. von Rosenvinge, György Baffy, Ildiko Halasz, Marcos Pedrosa, Lyn Sue Kahng, Riaz Cassim, Katarina B. Greer, Margaret Kinnard, Divya Bhatt, Kerry B. Dunbar, William V. Harford, John A. Mengshol, Jed Olson, Swati Patel, Fadi Antaki, Deborah A. Fisher, Brian A. Sullivan, Christopher Lenza, Devang Prajapati, Helen Wong, Rebecca J. Beyth, John Lieb, Joseph Manlolo, Fernando V. Ona, Rhonda A. Cole, Natalia Khalaf, Charles J. Kahi, Divyanshoo R. Kohli, Tarun Rai, Prateek Sharma, Jiannis Anastasiou, Curt H. Hagedorn, Ronald Fernando, Christian S. Jackson, M. Mazen Jamal, Robert H. Lee, Farrukh H. Merchant, Folasade P. May, Joseph R. Pisegna, Endashaw Omer, Dipendra Parajuli, Adnan Said, Toan D. Nguyen, Claudio Tombazzi, P. A. Feldman, Leslie Jacob, Rachel Koppelman, Kyle P. Lehenbauer, Deepak Desai, Mohammad F. Madhoun, William M. Tierney, Minh Q. Ho, H Hockman, Christopher D. Lopez, Emily Carter Paulson, Martin Tobi, Hugo Pinillos, Michele Young, Nancy Ho, Ranjan Mascarenhas, K. Promrat, Pritesh Mutha, William M. Pandak, Tilak Shah, Mitchell L. Schubert, Frank S. Pancotto, Andrew J. Gawron, Amelia E. Underwood, Samuel B. Ho, Priscilla Magno-Pagatzaurtundua, Doris H. Toro, Charles Beymer, Andrew M. Kaz, Jill E. Elwing, Jeffrey Gill, Susan F. Goldsmith, Michael Yao, Petr Protiva, Heiko Pohl, Tassos C. Kyriakides, Elaine Kleiner, Kathy Sullivan

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Concepts: Colonoscopy, Medicine, Colorectal cancer, Fecal occult blood, Veterans Affairs, Logistic regression, Descriptive statistics, Cohort, Randomized controlled trial, Randomization, Cancer, Internal medicine, Demography, Statistics, Mathematics, Sociology

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