OBJECTIVES: To assess general public perceptions (aged 50 and above) of colorectal screening value, and knowledge of options available.

METHODS: A random US sample of adults, aged 50 and older with health insurance, were invited to participate in an online survey administered by Qualtrics® in October 2018. Instrument was developed with input from one public health faculty and three pharmacists with expertise in gastroenterology and health outcomes.

RESULTS: 1,732 US adults (Mean=62.1yrs, SD=7.8), predominantly female (73%), white (77%), acquiring their health insurance through their employers/Medicare (79%), with at least some college education (70%), and average household incomes completed surveys. Respondents stated 92% had a usual doctor they frequented: colonoscopy screening was recommended by only 75% of physicians, 30% did not have a colonoscopy within 6 months of their providers’ recommendation, and 37% have never had colorectal screening. Almost all respondents (94%) knew why colorectal screening was recommended. Respondents avoided colonoscopy because they considered: preparation disagreeable (96%), fear perforation (96%), fear cancer 96%), anesthesia (95%), modesty (95%), didn’t feel they are at risk (no family history/no symptoms 91%), fear pain/discomfort (88%), cost (15%), ‘didn’t want it’, ‘inconvenience,’ and ‘procrastination.’ Only 35% of respondents were advised of alternatives to colonoscopy: DNA stool test (Cologuard^® 23%), gFOBT/iFOBT/FIT (14%), pill camera colonoscopy (PILLCam^TM ,2%), CT colonoscopy (3%), flexible sigmoidoscopy (4%), double contrast barium enema (2%) and Septin9 DNA blood test (Epi proColon^® <1%).

CONCLUSIONS: Respondents avoid colonoscopies, even though they understand why this test is performed. Most respondents are unaware of alternatives available for colorectal screening without the inconvenience, modesty concerns, or fear associated with colonoscopies. Given the variety of less invasive options now available for colorectal screening, patients’ attitudes and concerns towards screening must be considered by providers in a shared decision making model, in order to successfully engage patients in colon cancer screening.