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- Title
Provider recommendations for colorectal cancer screening in elderly veterans.
- Authors
Kahi, Charles J.; van Ryn, Michelle; Juliar, Beth; Stuart, Jennifer Schaffter; Imperiale, Thomas F.
- Abstract
<bold>Background: </bold>Decisions regarding colorectal cancer (CRC) screening in the elderly depend on providers' assessment of likelihood of benefit partly based on patient comorbidity and past screening history. We aimed to describe providers' experiences and practice patterns regarding screening for CRC in elderly patients in the VA system.<bold>Methods and Participants: </bold>A survey was sent to VA primary care providers who had previously participated in the CanCORS-sponsored Share Thoughts on Care study and at a VA medical center. The surveys consisted of clinical vignettes that varied by patient age (75, 80, or 85 years), comorbidity, and past CRC screening history.<bold>Main Results: </bold>Completed questionnaires were received from 183 of 351 providers (52%). Ninety-five percent of providers would recommend screening for a healthy 75 year old compared to 66% and 39% for a healthy 80 and 85 year old, respectively (p-values < 0.0001). Providers were more likely to recommend screening for a 75 year old with moderate CHF versus severe CHF [61% versus 15%, OR 9.0 (95% CI 5.8-14.0), p < 0.0001] and more likely to recommend screening for an 80 year old with prior colonoscopy within the preceding 10 years, versus 5 years [42% versus 23%, OR 2.6 (95% CI 1.9-3.5), p < 0.0001]. A substantial minority of respondents (range 15-21%) reported they would screen a 75 year old with an active malignancy, severe CHF, or severe COPD. Provider demographic characteristics were not significantly associated with the probability of a screening recommendation.<bold>Conclusions: </bold>VA providers incorporate patient age, comorbidity, and past CRC screening history into CRC screening recommendations for elderly veterans; however, substantial proportions of these recommendations are inappropriate.
- Subjects
UNITED States; COLON cancer; MEDICAL screening; DISEASES in veterans; COMORBIDITY; MEDICAL research; VETERANS' hospitals; RESEARCH; LIFE expectancy; AGE distribution; RESEARCH methodology; EARLY detection of cancer; EVALUATION research; MEDICAL cooperation; COLORECTAL cancer; PATIENTS' attitudes; COMPARATIVE studies; RESEARCH funding; VETERANS; HEALTH planning
- Publication
JGIM: Journal of General Internal Medicine, 2009, Vol 24, Issue 12, p1263
- ISSN
0884-8734
- Publication type
journal article
- DOI
10.1007/s11606-009-1110-x