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
Authors: Robertson Douglas J. , Dominitz Jason A. , Beed Alexander , Boardman Kathy D. , Del Curto Barbara J. , Guarino Peter D. , Imperiale Thomas F. , LaCasse Andrew , Larson Meaghan F. , Gupta Samir , Lieberman David , Planeta Beata , Shaukat Aasma , Sultan Shanaz , Menees Stacy B. , Saini Sameer D. , Schoenfeld Philip , Goebel Stephan , von Rosenvinge Erik C. , Baffy Gyorgy , Halasz Ildiko , Pedrosa Marcos C. , Kahng Lyn Sue , Cassim Riaz , Greer Katarina B. , Kinnard Margaret F. , Bhatt Divya B. , Dunbar Kerry B. , Harford William V. , Mengshol John A. , Olson Jed E. , Patel Swati G. , Antaki Fadi , Fisher Deborah A. , Sullivan Brian A. , Lenza Christopher , Prajapati Devang N. , Wong Helen , Beyth Rebecca , Lieb John G. , Manlolo Joseph , Ona Fernando V. , Cole Rhonda A. , Khalaf Natalia , Kahi Charles J. , Kohli Divyanshoo Rai , Rai Tarun , Sharma Prateek , Anastasiou Jiannis , Hagedorn Curt , Fernando Ronald S. , Jackson Christian S. , Jamal M. Mazen , Lee Robert H. , Merchant Farrukh , May Folasade P. , Pisegna Joseph R. , Omer Endashaw , Parajuli Dipendra , Said Adnan , Nguyen Toan D. , Tombazzi Claudio Ruben , Feldman Paul A. , Jacob Leslie , Koppelman Rachel N. , Lehenbauer Kyle P. , Desai Deepak S. , Madhoun Mohammad F. , Tierney William M. , Ho Minh Q. , Hockman Heather J. , Lopez Christopher , Carter Paulson Emily , Tobi Martin , Pinillos Hugo L. , Young Michele , Ho Nancy C. , Mascarenhas Ranjan , Promrat Kirrichai , Mutha Pritesh R. , Pandak William M. , Shah Tilak , Schubert Mitchell , Pancotto Frank S. , Gawron Andrew J. , Underwood Amelia E. , Ho Samuel B. , Magno-Pagatzaurtundua Priscilla , Toro Doris H. , Beymer Charles H. , Kaz Andrew M. , Elwing Jill , Gill Jeffrey A. , Goldsmith Susan F. , Yao Michael D. , Protiva Petr , Pohl Heiko , Kyriakides Tassos ,   CONFIRM Study Group, Kleiner Elaine , Sullivan Kathy , O'Leary John , Chiu Wai (Susannah) , Huang Hairong , Russo John , Johnson Gary , Antonelli Peg , Burns Amy , Peduzzi Peter , Ciarleglio Maria , O'Connor Theresa , Wallace Robert , Williams Alicia , Tommessilli Lynn , Taylor Sakasha , Pitts Sarah , Mancini Lesley W. , O'Brien Peggy , O'Neil Susan , Perry Mavis , McBride Vanessa , Carr Wanda , Joncas Carmelene , O'Donnell Elizabeth , Sather Mike , Warren Stuart , Conner Todd , Honstein Ernestine , Sutton Theresa , Putnam Tracey , Branham Kevin , Argyres Dean , Peterson Dianne , Kennedy April , Carrick Toni , Apodaca Carlos , Eden Gary , Martinez Talaya , Tripp Cindy , Nicholson Michelle , Schwartz Amy , Felix Monique , Ward Angela , Marquez Leanne , Lovato Karsondra , Cochran Neil , Tapia Steve , VanRaden Melissa , Badgett Carol , Taylor Zach , Pontzer Jimmy , Dorman Bert , Chavez Michael , Georg Sharon , Templton Terri , Calais Lawrence , Haakensen Claire , Curtis Barbara , Prehoda Michelle , Colling Cindy , Older Dave , Apodaca Gloria , Sova Julia , Klee Magnolia C. , Wolfram-Aduan Antigone , Ulatowski Michael J. , Hamilton Brittney L. , Bopp
(Formerly England) Kayla M. , Ford Gashia M. , Lace Ngaio E. , McDonnell William A. , Piehl Gina C. , Patel-Ejarque Nazleen , Berry Maegan , Strubeck Eric A. , Chesnut Leigh , Burridge Laurie J. , Bean Jennifer R. , Kowal Lynda M. , Voorhees
(Formerly Rose) Amy V. , Ridley Amy , Croteau Heike B. , Bessett Kate A. , Fletcher Carol , Barbaresso Michelle , Drummond Alysia , Belanger Karen , McRobert Erin , Myers Aimee , Trumble Erika , Rose Patricia , Biswas Anita , Enache Eric , Shankin Matthew , Strunk Danielle , Simpson Andrew , Harrison Melanie , Prasad Meena , Robinson Pauline , Flores Alegandro , Jananeh Sara , Tanukonda Sridhar , Ahmadi-Izadi Ghazal , Madihi Shahrzad , Raufman Jean-Pierre , Grady Deborah , Britton Angela , Goldstein Carly , Thomas Michelle , Lee Veronica , Belizaire Myrdell , Costa Caroline , Davis Samuel , Decker Makaila , Marrama Ashley , Gilroy-Fanaras Dorothy , Gass Jesse , Reece Scott , Tobin Desiree , Carroll Robert , Ferreira Maria , Irvin Dawn , Morken Victoria , Covelli Michael , Medina Teodoro , Schiebel Frank , Shreves Anna , Shriver Donald , Frederick Yvonne , Postle (formerly Matheny) Candice , Shaw Jessica , Pastor Dorothy , Armstrong Anna , Kumaran Vinay , Pinto April Jessica , Marshall Vanessa , McLarty Stacye , Carlton James , Murphy Kenneth , McLemore Kourtney , Mortensen Eric , LePage James , Willis Cyenthia , Berman Kenneth , Dunn Theresa , Espinoza Jeannine , Schleski Eugenia (Jean) , Shrader Stephanie , Gropp Kevin , Kanaan Ziad , Miller Lawrence , Anees Mohammad , Judd Stephanie , Berchou Vicki , Balogh Deann , Jones Elizabeth , Covert Kathleen 'Kelly' , Davis Yolanda , Marbury Cynthia , Rambus MaryAnn , Olgren Erin , Gellad Ziad , Sullivan Brian , Day Teresa , Teehan Sima , Peters Laura , Hernandez-Chavez Raquel , Murphy Eva , Cherry Judy (Christine) , Graham Edwin , Johnson Judith , Wooten William , Trujillo Jesus , Harris Maurice , Alizadeh Mary , Lo Margaret , Sultan Shannaz , Brown Leslie , Koster Lauren , LeLaurin Jennifer , Irwin Anne , Kay Nicole , Mckillip Sean , Lowe Mark , Yeralan Seyhun , Leehey David , McBurney Conor , Jain Amod , Park Thomas , Broadwater Latonia , El-Serag Hashem , Shaib Yassir , Taylor Eric , Nair Paayal , Broussard Emily , Gibson Erica , Hawkins Rollin , Natividad Tammy , Courtade Daisy , Palmer Mayuri (Ezzie) , Martinez Stephanie , Panagiotis Kougias , Morrow Curlie , Ballard Carrie , Barker Barry , Garner Mikayla , McCalley Stephanie , Schwartzkopf Ashley , Wright Anita , Titi Mohammad , Higbee April , Pratiksha Singh , Jones April , Shipe Tracey , McKee Jason , Vennalaganti Raghuram , Terrey Kira , Maruf Lubna , Brown Daniel , Crouse Elaine , Marchant-Miros Kathy , Ussery Betty , Ducker Loretta , Estell Jennifer , Porchia Sylvia , Kim Mi Ye , Kim Christina , Chan Bobby , Hayton Amy , Christiansen Harini , Peterson Myra , Ding Guizhi (Grace) , Simpson Vicki , Read Sonia , Mamani Gabriela , Salazar Jordan , Kato Joann , Bowie Michael , Carnevale Ryan , Halim Mark , Sahagian Anita , Ibarra Allison , Travis Zachary , Garcia Julia , Gill Abneet , Starzyk John , Sumarli Samantha , Johnson Valanteena , Peresuh Simbiso , Quimby Traci , Cordova Rick , Herold Lauren , Hawley Angela , Goo Tyralee , Kidao Jayashri , Lee Robert , Freidel Collin , Gutierrez Evelyn , Noorisharghi Negar , Ivie Gabrielle Evanne-Mignon , Jawish Tamara , Partin Steven , Yoo Grace , Fabilane Charina , Noori Nikoo , Lang Elizabeth , Senen Shazie , Partin Stephen , Fathi Moe , Chauvin Rachel , Feiger Jeremy , Reataza Marielle , Morgan Timothy , Asghar Aliya , Jacobs Jonathan , Kashefi Mehran , May Folasade , Ohning Gordon , Padua David , Smutko Victoria , Oh David , Kosoyan Hovsep , Dreskin Benjamin , Luu Kayti , Alas Alexander , Bharath Purnima , Dixit Vivek , Sanford** Daniel , Vu John , Kadi Samar , Nwajuaku Tracy , Smith June , Kincaid Jenevieve , Mir Mohammed , Lanceta Joel , Rice John , Agarwal Parul , Augustine Alexia , Prickel Helene , Vue Jenny , Guerrero Kevin , Levenson Stewart , Aguilera-Fish Andres , Chestnut Leigh , Jobse Bruce , Lombardo Cathy , Silver Trudi , Ahmed Nazneen , Bockhold Kathleen , Koppelman Rachel , Carneiro Flavia Rosa , Garcia-Morales Rolando , Spector Daniel , Gomez Jose , Lehenbauer Kyle , Reinink Andrew , Anway Ruth , Evans-Lindquist Mary , Eggers Thomasine , Green Michele , Pretti Alex , Meyeraan Tacy , Condon Debra , Cavanagh Mary , DeFalco Colleen M. , Cutting Jacqueline , Joseph Kurt , Dean Stephanie , Mitchell Stephanie , Phillips Vickie , Krueger Chelsey , Zink Donna , Goldberg Kenneth , Patel Nitin , Martinez Gonzalez Maria , Davis-Underwood Heather , O'Sullivan Andrea , Suppes Trisha , Bratcher Karen , Stern David , Wu Richard , Damisa Jibreel , Warsi Rahma , Nguyen Tam , Pinillos Hugo , Flowers Erin , Kuramoto Angela , Thurmond Charles , Orozco Lisa , Farrell Gail , Jaynes Rodney , Saenz Perfecto , Perez Cassandra , Collins Judith , Lin Emery , Onstad Laura , Pitts Alexandra , Osborn Kevin , Kenworthy-Heinige Tawni , Casey Andrew , Gold Deanna , Olivo Cosette , Joos Sandra , Subramanian Sandhya , Forro Vanessa , Cannady Allina , Usih Joy , Raitt Merritt , Flynn Maura , Shittu Yetunde , Jawaid Muhammad , Anderson Rebecca , Poole Deanna , Butler Celia , Snead Leanne , Christine Hayden , Swanson Gina , Heumann Douglas , Pandak William , Spataro Joseph , Bajaj Jasmohan , Solomon Cynthia , Smith Gilles HoChong , Zafass Alvin , Tilak Shan , Fuchs Michael , Davis Margaret , Blackman Lou , Lemler Jennifer , Munsey Rachel , Deebo Jeanette , McCarthy Jane , Noel Megan , Hurley Robin , Zurowski Wayner , Sharpe Angela , Wilson Krystina , Peets Risa , Lorenso Benjamin , Burrison Stephanie , Johnson Dorothea , Angelovic Aaron , Erickson Nathan , Hanson Heather , Bailey Travis , Genung Kim , Dulin Heather , Neuharth Renee , Clegg Daniel , Velarde Kandi , Dever John , Murphy Mary , Beck Danielle , Wasil Michelene , Vazquez Jason , O'Neil Ellen , Ganji Gelareh , Ducom Julie , Lee Maria , Hovespians Rita , Margolis Jessie , Simmons Brittni , Sweeney (formerly St. Martin) Jennifer , Henry Robert , Martin-Ortiz Jose , Santiago-Rivera Loscar , Gonzalez - Aviles Gladys , Pedrosa Carmen , Bird-Caceres Juan , Padilla Brunilda , Baez-Corujo Fernando , Martinez- Ortiz Yaiza , Vazquez Ekie , Grigg-Gutierrez Nicole , Laboy-Olivieri Carlos , Urbina-Velez Rafael , Andrews Sarah , Rosa-Cruz Sheryl , Tirado-Montijo Rafael , Otero-Aponte Kayssa , Martinez-Martino Michelle , Freire Arnaldo , Soto-Ramos Antonio , Santana-Perez Margarita , Araujo James , Vanderwarker Christopher , Alexander Jeremiah , Nevins Elaine , LaGuire Julie , Guerrero Linda , Piehl Gina , Jenkins Meredith , Chen Teresa , Jang Jessica , Tanus Adrienne , McKelvy Patricia , Sayuk Gregory , Chandiramani Pooja , Vargo
(Formerly Shoults) Lindsey , Vargo Kristin , Lawrence Sara , Blythe Kelly , Goldsmith Susan , Campbell Robert , Craddock Mary Agnes , Amodeo Donald , Reinhard Rebecca , Durant Brittany , Wells Breanna , Zoble Adam , Papademetriou Marianna , Roche Nada , Adler Priscilla , Krishna Asha , Glaze Delmonica , Wijegunawardana Dinuka , Yeroushalmi Samuel , Laine Loren , Mautner Raeleen , Bugaj Julie , Anderson Joseph , Croteau Heike , Kingman Linda , Burridge Laurie 
Published: July 2023

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 &amp;lt; .001) or other screening tests (46 [1.0%] P &amp;lt; .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.