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Colonoscopy or other screening? Help your patient decide
September 22, 2023

This article is for primary care providers, gastroenterologists, and your clinical staff who suggest colorectal cancer screenings for patients

Shared decision making is a powerful tool when choosing the best treatment plan for your patients. When patients collaborate with their doctor, they’re more likely to advocate for themselves and learn more ways to treat and manage their condition.

In early October, we’ll start surveying members to find out whether they’ve talked to their health care provider about the various options for colorectal cancer screenings.

Results of these surveys will help:

  • Inform future guidance around shared decision making.
  • Improve the member experience when it comes to provider interactions.
  • Improve quality measures around preventive care.

Here’s a link to our survey so you can see a sample of what we’ll ask our members.

Shared decision making is ethical, high-quality care

Mark Friedberg, MD, MPP
Senior Vice President, Performance Measurement & Improvement
Blue Cross Blue Shield of Massachusetts

"From an ethical standpoint, the best approach is to carefully explain to your patients the scientific evidence concerning all of the screening options available to them, to talk through the pros and cons of each screening option, to ask which screening option each patient wants, and to help each patient receive their chosen screening method,” says Mark Friedberg, MD, MPP, Blue Cross’ senior vice president, Performance Measurement & Improvement.

  We believe the future of quality measurement should be grounded firmly in ethical principles that emphasize respect for persons and informed consent—which includes explaining all options for cancer screening.  

Blue Cross conducted a pilot survey with members in March of 2023. The results suggested that the majority of our average-risk members who had a screening colonoscopy were never told about any other option. Adds Friedberg, "Studies of shared decision making strongly suggest that offering only colonoscopies lowers overall screening rates and worsens inequities in colorectal cancer screening rates.”

We anticipate reporting performance of shared decision making back to provider organizations as a starting point later this year.

US Preventive Services Task Force recommendations

When it comes to colorectal cancer screening, US Preventive Services Task Force recommends adults 45-75 should be screened for colorectal cancer. On their Colorectal Cancer Screening page, they list the various stool-based and direct visualization options and evidence.

  We recommend reviewing the types of evidence for these screening modalities.


Source: JAMA. US Preventive Services Task Force. Recommendation Statement. Retrieved August 2023 at uspreventiveservicestaskforce.org.

Shared decision making in action

Some practices, such as Beth Israel Lahey Health Performance Network, have developed materials (translated into multiple languages) to help their patients understand their options and to give them a list of questions to ask their doctors as conversation starters.

Research shows that when providers explain all of a patient’s options and ask for and respect their values and preferences, patients are more likely to follow through with treatment and experience better health outcomes overall, according to Kim Ariyabuddhiphongs, associate chief medical officer at BILH's Performance Network.                                

Improving screening rates together

By surveying our members, we hope to help you improve your patients' experience and increase rates of colorectal cancer screening in an ethically sound manner.


US Preventive Services Task Force Colorectal Cancer: Screening
Doctor—and patient—know best