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Physician Decision Making for Colorectal Cancer Screening in the Elderly

  • Original Research
  • Published:
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ABSTRACT

BACKGROUND

Although individualized decision making is recommended to appropriately screen for colorectal cancer (CRC) in older adults, it is unclear whether physicians solicit input from older patients before making a recommendation for or against CRC screening.

OBJECTIVE

The purpose of this study was to examine whether physicians elect to engage older patients in individualized decision making for CRC screening.

DESIGN AND PARTICIPANTS

We surveyed a random sample of 650 US primary care physicians by mail. Physicians responded to questions about three clinical vignettes involving 80-year-old female patients in good, fair, and poor health. We examined whether physicians reported that they would initiate a discussion with the patients about CRC screening and whether they would make a recommendation about screening or seek patient input first.

RESULTS

A total of 276 eligible physicians responded (52 % corrected response rate). Whether physicians indicated they would initiate a discussion about CRC screening varied by vignette: 91 % of physicians indicated they would do so for the patient in good health and 66 % and 44 % for the patients in fair and poor health, respectively (p<0.0001). The proportion of physicians that would seek patient input for their screening recommendation also varied by vignette (45 % for good, 49 % for fair, and 26 % for poor).

CONCLUSION

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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Acknowledgments

This manuscript was presented as a poster at the 30th Society for Medical Decision Making Meeting in Philadelphia, PA, October 20, 2008.

Dr. Lewis was funded by a National Cancer Institute K07 Mentored Career Development Award (K07 CA104428).

Dr. Pignone was funded by a National Cancer Institute Established Investigator Award (K05 CA129166).

Dr. Esserman was funded by a National Institutes of Health Clinical and Translational Science Award (Grant UL1RR025747).

Dr. Lewis had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Conflict of Interest

The authors declare that they do not have any conflicts of interest.

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Authors and Affiliations

  1. Department of Medicine, Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill, NC, USA

    Carmen L. Lewis MD, MPH, Denise Esserman PhD, Michael P. Pignone MD, MPH & Carol Golin MD, MPH

  2. Cecil G Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA

    Carmen L. Lewis MD, MPH, Christopher DeLeon MA, Michael P. Pignone MD, MPH, Donald E. Pathman MD, MPH & Carol Golin MD, MPH

  3. Department of Biostatistics, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA

    Denise Esserman PhD

  4. Department of Family Medicine, UNC School of Medicine, Chapel Hill, NC, USA

    Donald E. Pathman MD, MPH

  5. Department of Health Behavior and Health Education, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA

    Carol Golin MD, MPH

  6. UNC Hospitals, 5039 Old Clinic Building, CB #7110, Chapel Hill, NC, 27599-7110, USA

    Carmen L. Lewis MD, MPH

Authors
  1. Carmen L. Lewis MD, MPH
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  2. Denise Esserman PhD
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  3. Christopher DeLeon MA
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Correspondence to Carmen L. Lewis MD, MPH.

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Lewis, C.L., Esserman, D., DeLeon, C. et al. Physician Decision Making for Colorectal Cancer Screening in the Elderly. J GEN INTERN MED 28, 1202–1207 (2013). https://doi.org/10.1007/s11606-013-2393-5

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  • DOI: https://doi.org/10.1007/s11606-013-2393-5

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