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.


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

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JAMA Netw Open


washington; spokane; pshmc; Adult; Humans; Female; Male; Middle Aged; Early Detection of Cancer; Occult Blood; Cross-Sectional Studies; Neoplasms; Colonoscopy


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.

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