Colorectal cancer screening discussions: Maybe 3As is enough?

7 Background: We evaluate the association of the 5A steps as recommended by the US Preventive Services Task Force (i.e., assess, advise, agree, assist and arrange) with adherence to physician-recommended colorectal cancer (CRC) screening. Methods: Audio-recordings of periodic health exams (PHEs) were joined with electronic medical record data and pre-visit patient surveys. Association of the 5A steps, as coded from audio-recordings, with CRC screening use was assessed using generalized estimating equation approaches. Results: Physician participants (n=64) were salaried primary care physicians. Patient participants (n=444) were insured, aged 50-80 years and due for CRC screening. Virtually all visits (n=415) included a discussion of CRC screening. When CRC screening was discussed, patients almost always (99%) received a physician recommendation for screening (advise). Over half were given assistance in obtaining screening (assist, 59%) and told why they were eligible for screening (assess, 56%). Few negoti...