• Alex H Krist, Camille J Hochheimer, Roy T Sabo, Jon Puro, Eric Peele, Paulette Lail-Kashiri, and Sally W Vernon.
• From the Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond (AHK, CJH, RTS, PL-K), Department of Biostatistics, Virginia Commonwealth University, Richmond (CJH, RTS); OCHIN, Portland, OR (JP), RTI International, Research Triangle Park, NC (EP), Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston (SWV). alexander.krist@vcuhealth.org.
• J Am Board Fam Med. 2020 Sep 1; 33 (5): 779-784.

IntroductionScreening for colorectal cancer is beneficial. Yet, screening remains suboptimal, and underserved populations are at greater risk for not being appropriately screened. Although many barriers to screening are understood, less is known about how the decision-making process on whether to receive colonoscopy or stool testing influences screening.MethodsAs part of a randomized controlled trial to test engaging underserved populations in preventive care through online, personalized, educational material, 2417 patients aged 50 to 74 years were randomly selected from the 70,998 patients with an office visit the year prior and mailed a survey to assess decision-making for colorectal cancer screening. Twenty practices in practice-based research networks from 5 diverse states participated. Survey data were supplemented with electronic health record data.ResultsAmong respondents, 64% were or became up to date with screening within 3 months of their office visit. The main factor associated with being up to date was the length of the patient-clinician relationship (<6 months vs 5+ years: odds ratio [OR], 0.49; 95% CI, 0.30-0.80). Sharing the decision about screening options with the clinician was a predictor for being up to date compared with patients who made the decision for themselves (OR, 1.75; 95% CI, 1.27-2.44). Only 36% of patients reported being given a choice about screening options. Traditional factors like race, employment, insurance, and education were not associated with screening.ConclusionsHaving a long-term relationship with a primary care clinician and sharing decisions may be key drivers to ensure evidence-based preventive care for underserved populations.© Copyright 2020 by the American Board of Family Medicine.

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