Physicians’ Decisions About Continuing or Stopping Colon Cancer Screening in the Elderly: A Qualitative Study

Abstract

BACKGROUND: Experts suggest an individualized approach to colon cancer screening to take into account variation in older adults' life expectancies and potential to benefit from screening. However, little is known about how physicians make decisions about colon cancer screening in adults age 75 and older.OBJECTIVE: To understand whether physicians employ individualized decision making for colon cancer screening in older adults, and, if so, to determine the individual factors they believed were important to consider in making such decisions. DESIGN: Qualitative research using focus groups and individual interviewsPARTICIPANTS: Fifteen primary care physicians practicing in community settings participated in three focus groups and two interviews. APPROACH:We used two clinical vignettes of 78-yearold women in fair and poor health states to stimulate discussions about clinical decision making for CRC screening in older adults. RESULTS:Physicians considered a wide range of factors, including clinical factors, such as age, life expectancy, co-morbidities, and functional status, as well as individual factors, such as personality, previous screening behavior, family support, and the relationship with the patient. Physicians reported difficulty with these decisions because of their complexity and because they involve life expectancy estimates. Their approach and discussion with patients seemed to be dependent on the degree of certainty they perceived regarding their clinical assessment as to whether the patient had the potential to benefit from screening. CONCLUSIONS:Colorectal cancer screening decision making is complex. Physicians reported using a range of clinical and individual factors to decide about colorectal cancer screening in older adults.KEY WORDS: colon cancer screening; decision making; elderly.

Primary Care Practitioners’ Views on Incorporating Long-term Prognosis in the Care of Older Adults

“…1,4,8–11 Previous studies 35–39 showed conflicting results on whether practitioners incorporated life expectancy in cancer screening decisions. Our results add to the literature by highlighting that patient age modulated the effect that prognosis had on clinical decisions for patients with a poor long-term prognosis.…”

Primary care providers' perspectives on discontinuing prostate cancer screening

“…The statements were developed based on previous survey instruments, 18 qualitative research 16,19 and in pre-testing with providers in Baltimore. Responses were dichotomized into agree and strongly agree versus neither agree nor disagree, disagree, and strongly disagree.…”

“…Previous research on colorectal cancer has reported that decisions to stop screening are complex and involve an assessment of patients’ clinical factors and functional status. 16,17 …”

Cultural challenges to engaging patients in shared decision making

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