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Provider Recommendations for Colorectal Cancer Screening in Elderly Veterans

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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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Acknowledgments

Grant support: VA Young Investigator Award (Dr. Kahi) and in part grant K24 DK02756 (Dr. Imperiale).

Conflict of Interest Summary

None disclosed.

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Authors and Affiliations

  1. Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 1481 W 10th street C-7055, Indianapolis, IN, 46202, USA

    Charles J. Kahi MD, MSc, FACP & Thomas F. Imperiale MD

  2. The Richard L. Roudebush VA Medical Center, Indianapolis, USA

    Jennifer Schaffter Stuart BA

  3. Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA

    Michelle van Ryn PhD, MPH

  4. Department of Biostatistics, Indiana University, Indianapolis, USA

    Beth Juliar MS, MA

  5. Regenstrief Institute, Inc., Indianapolis, IN, USA

    Thomas F. Imperiale MD

  6. Gastroenterology, Roudebush VAMC, 1481 W 10th street C-7055, Indianapolis, IN, 46202, USA

    Charles J. Kahi MD, MSc, FACP

Authors
  1. Charles J. Kahi MD, MSc, FACP
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  2. Michelle van Ryn PhD, MPH
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  3. Beth Juliar MS, MA
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  4. Jennifer Schaffter Stuart BA
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  5. Thomas F. Imperiale MD
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Corresponding author

Correspondence to Charles J. Kahi MD, MSc, FACP.

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Kahi, C.J., van Ryn, M., Juliar, B. et al. Provider Recommendations for Colorectal Cancer Screening in Elderly Veterans. J GEN INTERN MED 24, 1263–1268 (2009). https://doi.org/10.1007/s11606-009-1110-x

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  • DOI: https://doi.org/10.1007/s11606-009-1110-x

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