Physician Decision Making for Colorectal Cancer Screening in the Elderly

Lewis, Carmen L.; Esserman, Denise; DeLeon, Christopher; Pignone, Michael; Pathman, Donald E.; Golin, Carol E.

doi:10.1007/s11606-013-2393-5

Cited by 22 publications

(24 citation statements)

References 30 publications

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“…Estimate lag time (time horizon) to benefit: Time to benefit for treatments (lag time) may be longer than the individual's projected life span, and varies for different interventions Consider time frames of 1 to 2, 2 to 5, 6 to 10, and 10 or more years Determine patients' readiness to discuss their trajectory or prognosis Patients vary in how much and how they wish to discuss health trajectory and prognosis .…”

Section: Actions and Action Steps For Care Of Older Adults With Mccsmentioning

confidence: 99%

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Decision Making for Older Adults With Multiple Chronic Conditions: Executive Summary for the American Geriatrics Society Guiding Principles on the Care of Older Adults With Multimorbidity

Boyd

Smith

Masoudi

et al. 2019

J American Geriatrics Society

221

174

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Caring for older adults with multiple chronic conditions (MCCs) is challenging. The American Geriatrics Society (AGS) previously developed The AGS Guiding Principles for the Care of Older Adults With Multimorbidity using a systematic review of the literature and consensus. The objective of the current work was to translate these principles into a framework of Actions and accompanying Action Steps for decision making for clinicians who provide both primary and specialty care to older people with MCCs. A work group of geriatricians, cardiologists, and generalists: (1) articulated the core MCC Actions and the Action Steps needed to carry out the Actions; (2) provided decisional tips and communication scripts for implementing the Actions and Action Steps, using commonly encountered situations: (3) performed a scoping review to identify evidence‐based, validated tools for carrying out the MCC Actions and Action Steps; and (4) identified potential barriers to, and mitigating factors for, implementing the MCC Actions. The recommended MCC Actions include: (1) identify and communicate patients' health priorities and health trajectory; (2) stop, start, or continue care based on health priorities, potential benefit vs harm and burden, and health trajectory; and (3) align decisions and care among patients, caregivers, and other clinicians with patients' health priorities and health trajectory. The tips and scripts for carrying out these Actions are included in the full MCC Action Framework available in the supplement (http://www.geriatricscareonline.org). J Am Geriatr Soc 67:665–673, 2019.

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Section: Actions and Action Steps For Care Of Older Adults With Mccsmentioning

confidence: 99%

Section: Actions and Action Steps For Care Of Older Adults With Mccsmentioning

confidence: 99%

Decision Making for Older Adults With Multiple Chronic Conditions: Executive Summary for the American Geriatrics Society Guiding Principles on the Care of Older Adults With Multimorbidity

Boyd

Smith

Masoudi

et al. 2019

J American Geriatrics Society

221

174

View full text Add to dashboard Cite

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“…PCPs often individualize their CRC screening recommendations for older women by selecting to engage patients in discussions and seeking their input before making a CRC recommendation. PCPs are more likely to select to engage the patients represented by the good and fair health vignette where the potential benefits outweigh the potential harms than patients in poor health, where the potential harms outweigh the potential benefits 50.…”

Section: Barriers To Screeningmentioning

confidence: 99%

Screening for colorectal cancer: the role of the primary care physician

Triantafillidis

Vagianos

Gikas³

et al. 2017

European Journal of Gastroenterology &Amp; Hepatology

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In recent years, the role of primary care physicians (PCPs) in the diagnosis and management of gastrointestinal disorders, including screening for colorectal cancer (CRC), has been recognized as very important. The available data indicate that PCPs are not adequately following CRC screening guidelines because a number of factors have been identified as significant barriers to the proper application of CRC screening guidelines. These factors include lack of time, patient reluctance, and challenges related to scheduling colonoscopy. Further positive engagement of PCPs with CRC screening is required to overcome these barriers and reach acceptable levels in screening rates. To meet the expectations of modern medicine, PCPs should not only be able to recommend occult blood testing or colonoscopy but also, under certain conditions, able to perform colonoscopy. In this review, the authors aim to provide the current knowledge of the role of PCPs in increasing the rate and successfully implementing a screening program for CRC by applying the relevant international guidelines.

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“…Another approach to de‐implementing low‐value care would be excluding patients who are unlikely to live long enough to benefit from interventions, providing an opportunity to systematically address net‐harm for patients with limited life expectancy. This approach is consistent with a threshold approach to clinical decision making, where clinicians no longer pursue interventions likely to cause net‐harm . Further work extending these methods to EHR data, determining relevant threshold cut points, and integrating informatics tools within the EHR system directly may provide opportunities to enhance targeted de‐implementation efforts.…”

Section: Discussionmentioning

confidence: 57%

Development and validation of a 5‐year mortality prediction model using regularized regression and Medicare data

Lund

Kuo

Brookhart

et al. 2019

Pharmacoepidemiology and Drug

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Purpose De‐implementation of low‐value services among patients with limited life expectancy is challenging. Robust mortality prediction models using routinely collected health care data can enhance health care stakeholders' ability to identify populations with limited life expectancy. We developed and validated a claims‐based prediction model for 5‐year mortality using regularized regression methods. Methods Medicare beneficiaries age 66 or older with an office visit and at least 12 months of pre‐visit continuous Medicare A/B enrollment were identified in 2008. Five‐year mortality was assessed through 2013. Secondary outcomes included 30‐, 90‐, and 180‐day and 1‐year mortality. Claims‐based predictors, including comorbidities and indicators of disability, frailty, and functional impairment, were selected using regularized logistic regression, applying the least absolute shrinkage and selection operator (LASSO) in a random 80% training sample. Model performance was assessed and compared with the Gagne comorbidity score in the 20% validation sample. Results Overall, 183 204 (24%) individuals died. In addition to demographics, 161 indicators of comorbidity and function were included in the final model. In the validation sample, the c‐statistic was 0.825 (0.823‐0.828). Median‐predicted probability of 5‐year mortality was 14%; almost 4% of the cohort had a predicted probability greater than 80%. Compared with the Gagne score, the LASSO model led to improved 5‐year mortality classification (net reclassification index = 9.9%; integrated discrimination index = 5.2%). Conclusions Our claims‐based model predicting 5‐year mortality showed excellent discrimination and calibration, similar to the Gagne score model, but resulted in improved mortality classification. Regularized regression is a feasible approach for developing prediction tools that could enhance health care research and evaluation of care quality.

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Physician Decision Making for Colorectal Cancer Screening in the Elderly

Cited by 22 publications

References 30 publications

Decision Making for Older Adults With Multiple Chronic Conditions: Executive Summary for the American Geriatrics Society Guiding Principles on the Care of Older Adults With Multimorbidity

Decision Making for Older Adults With Multiple Chronic Conditions: Executive Summary for the American Geriatrics Society Guiding Principles on the Care of Older Adults With Multimorbidity

Screening for colorectal cancer: the role of the primary care physician

Development and validation of a 5‐year mortality prediction model using regularized regression and Medicare data

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