Provider Recommendations for Colorectal Cancer Screening in Elderly Veterans

Kahi, Charles J.; Ryn, Michelle van; Juliar, Beth E.; Stuart, Jennifer S.; Imperiale, Thomas F.

doi:10.1007/s11606-009-1110-x

Cited by 22 publications

(20 citation statements)

References 27 publications

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“…Physicians were found to be less likely to recommend screening when they anticipated their patients had fewer years to live and were more likely to seek patient input when they estimated an intermediate life expectancy. Although previous studies have demonstrated that practicing physicians report their screening recommendations vary by their patients' health state and life expectancy, [14][15][16] none to our knowledge have examined whether or not physicians elect to engage patients in individualized decision making before making CRC screening recommendations. In our pilot study involving internal medicine residents who responded to similar vignettes but at age 75 instead of aged 80, we found that 22 % of residents recommended against screening for the poor health vignette compared to 66 % of physicians in this current study.…”

Section: Discussionmentioning

confidence: 99%

“…Individualized decision making has been proposed to identify patients most and least likely to benefit from screening; 4 however, the role of patients in the individualized decision-making process has been unclear. Previous studies using patient vignettes to examine physicians' practices for CRC screening [14][15][16] have found recommendations are based on age and morbidity. A key aspect to individualized decision making not examined in these prior studies is whether primary care physicians elect to initiate discussions and seek patient input, thereby providing older patients the opportunity to express their preference for CRC screening.…”

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confidence: 99%

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Physician Decision Making for Colorectal Cancer Screening in the Elderly

et al. 2013

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We found that physicians often individualize their CRC screening recommendations for older women by electing to engage patients in discussions and seeking their input before making a CRC recommendation. Physicians were more likely to elect to engage the patients represented by the good and fair health vignette, where the potential benefits likely outweigh the potential harms, than the patient in poor health, where the potential harms likely outweigh the potential benefits.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Physician Decision Making for Colorectal Cancer Screening in the Elderly

et al. 2013

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“…1-4 The U.S. Preventive Services Task Force (USPSTF), for example, calls for routine screening for average risk individuals starting at age 50 years and continuing up to age 75 years. 1 Although clinicians are generally aware that factors other than age affect the effectiveness and cost effectiveness of CRC screening, 5 many make their decisions on screening for elderly individuals primarily based on age. This practice is in concordance with existing age-based guidelines and performance measures.…”

Section: Introductionmentioning

confidence: 99%

“…6 Moreover, a substantial minority of clinicians still offer CRC screening to elderly individuals with a life-expectancy less than 5 years. 5, 7-9 Hence, screening is not always targeted at those elderly individuals most likely to benefit.…”

Section: Introductionmentioning

confidence: 99%

Personalizing Colonoscopy Screening for Elderly Individuals Based on Screening History, Cancer Risk, and Comorbidity Status Could Increase Cost Effectiveness

et al. 2015

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Background & Aims Colorectal cancer (CRC) screening decisions for elderly individuals are often made based primarily on age—other factors that affect the effectiveness and cost effectiveness of screening are often not considered. We investigated the relative importance of factors that could be used to identify those elderly individuals most likely to benefit from CRC screening and determined the maximum ages at which screening remains cost effective based on these factors. Methods We used a microsimulation model (Microsimulation Screening Analysis-Colon) that was calibrated to the incidence of CRC in the US and the prevalence of adenomas reported in autopsy studies to determine the appropriate age to stop colonoscopy screening in 19,200 cohorts of individuals defined by sex, race, screening history, background risk for CRC, and comorbidity status. We applied a willingness-to-pay threshold of $100,000 per quality-adjusted life-year (QALY) gained. Results When considering the factors included in the model, a less intensive screening history, a higher background risk for CRC, and fewer comorbidities were associated with cost-effective screening at older ages. Sex and race had only a small effect on the appropriate age to stop screening. For some individuals likely to be screened in current practice, screening resulted in a loss of QALYs, rather than a gain. For some individuals unlikely to be screened in current practice, screening was highly cost effective. Although screening some previously screened, low-risk individuals was not cost effective even when they were 66 y old, screening some healthy, high-risk individuals remained cost effective until they reached an age of 88 y. Conclusion The current approach to CRC screening in elderly individuals, in which decisions are often based primarily on age, is inefficient, resulting in underuse of screening for some and overuse of screening for others. CRC screening could be more effective and cost effective if individual factors for each patient are considered.

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“…Another decision analysis also showed that the benefits of screening were outweighed by screening-related complication risks in subgroups of patients over 75, especially if they were in poor health [34] . Surveys have shown that providers do incorporate age and comorbidity in screening recommendations; however, their recommendations were often inconsistent with guidelines [43] . Other factors come into risks and benefits of colonoscopy in elderly patients.…”

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confidence: 99%

Performing colonoscopy in elderly and very elderly patients: Risks, costs and benefits

Lin

2014

WJGE

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Many diagnostic and screening colonoscopies are performed on very elderly patients. Although colonoscopic yield increases with age, the potential benefits in such patients decrease because of shorter life expectancy and more frequent comorbidities. Colonoscopy in very elderly patients carries a greater risk of complications and morbidity than in younger patients, and is associated with lower completion rates and higher likelihood of poor bowel preparation. Thus, screening colonoscopy in very elderly patients should be performed only after careful consideration of potential benefits, risks and patient preferences. On the other hand, diagnostic and therapeutic colonoscopy are more likely to benefit even very elderly patients, and in most cases should be performed if indicated.

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Provider Recommendations for Colorectal Cancer Screening in Elderly Veterans

Cited by 22 publications

References 27 publications

Physician Decision Making for Colorectal Cancer Screening in the Elderly

Physician Decision Making for Colorectal Cancer Screening in the Elderly

Personalizing Colonoscopy Screening for Elderly Individuals Based on Screening History, Cancer Risk, and Comorbidity Status Could Increase Cost Effectiveness

Performing colonoscopy in elderly and very elderly patients: Risks, costs and benefits

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