Provider recommendations for colorectal cancer screening in elderly veterans

Charles J. Kahi, Michelle Van Ryn, Beth Juliar, Jennifer Schaffter Stuart, Thomas F. Imperiale

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: 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. Methods and Participants: 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. Main Results: 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. Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)1263-1268
Number of pages6
JournalJournal of General Internal Medicine
Volume24
Issue number12
DOIs
StatePublished - Dec 2009
Externally publishedYes

Fingerprint

Veterans
Early Detection of Cancer
Colorectal Neoplasms
Comorbidity
History
Colonoscopy
Chronic Obstructive Pulmonary Disease
Primary Health Care
Demography
Surveys and Questionnaires
Neoplasms

Keywords

  • Aged
  • Colorectal cancer
  • Screening

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Kahi, C. J., Van Ryn, M., Juliar, B., Stuart, J. S., & Imperiale, T. F. (2009). Provider recommendations for colorectal cancer screening in elderly veterans. Journal of General Internal Medicine, 24(12), 1263-1268. https://doi.org/10.1007/s11606-009-1110-x

Provider recommendations for colorectal cancer screening in elderly veterans. / Kahi, Charles J.; Van Ryn, Michelle; Juliar, Beth; Stuart, Jennifer Schaffter; Imperiale, Thomas F.

In: Journal of General Internal Medicine, Vol. 24, No. 12, 12.2009, p. 1263-1268.

Research output: Contribution to journalArticle

Kahi, CJ, Van Ryn, M, Juliar, B, Stuart, JS & Imperiale, TF 2009, 'Provider recommendations for colorectal cancer screening in elderly veterans', Journal of General Internal Medicine, vol. 24, no. 12, pp. 1263-1268. https://doi.org/10.1007/s11606-009-1110-x
Kahi, Charles J. ; Van Ryn, Michelle ; Juliar, Beth ; Stuart, Jennifer Schaffter ; Imperiale, Thomas F. / Provider recommendations for colorectal cancer screening in elderly veterans. In: Journal of General Internal Medicine. 2009 ; Vol. 24, No. 12. pp. 1263-1268.
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abstract = "Background: 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. Methods and Participants: 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. Main Results: 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. Conclusions: 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.",
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AU - Juliar, Beth

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AU - Imperiale, Thomas F.

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N2 - Background: 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. Methods and Participants: 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. Main Results: 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. Conclusions: 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.

AB - Background: 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. Methods and Participants: 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. Main Results: 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. Conclusions: 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.

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