Background: Approximately 21.7 million US adults aged 50-75 years have never had colorectal cancer screening (CRCS). Self-reported CRCS confusion and control preference (i.e., preferred role in decision making) are known correlates of CRCS that may contribute to non-adherence.

Objective: We assessed the association between CRCS confusion and decision-making preferences (DMP).

Methods: Patients non-adherent to CRCS, 50-75 years, from 5 primary care practices, participated in the MyCRCS intervention. This secondary data analysis used 2016-2019 self-reported baseline and 3-month follow-up data (baseline analytic sample, N=680). Measures included CRCS Confusion Proneness Scale and subscales (e.g., overload, ambiguity), CRCS DMP (i.e., active, collaborative, passive), and demographics. Descriptive statistics were calculated including mean scale scores by DMP. Confounding was assessed and adjusted multinomial logistic regression modeling was conducted (Referent=collaborative DMP).

Results: Respondents were 39.6% male, 32.8% Black, and 30.9% had ≤ high school education. Overall, 45.8% had active and 14.8% had passive DMP. Mean confusion scale scores were statistically higher for passive DMP at baseline (p-value=0.036) and 3-month (p-value=0.013) compared to other groups. At 3-months, those with passive DMP had higher confusion overload (mean=9.37; p-value=0.019) and ambiguity (mean=12:37; p-value=0.006) scores compared to their DMP counterparts. At baseline, with each 1-unit increase in overload confusion respondents were less likely to prefer active compared to collaborative CRCS decision making (OR=0.946; 95% CI, 0.896–0.998).

Conclusion: This study provides the first evidence of a statistically significant and meaningful association between confusion and CRCS DMP, suggesting it may be useful to promote collaborative decision making to increase CRCS.