Impact of Knowledge and Risk Perceptions on Older Adults’ Intention for Surveillance Colonoscopy

Abstract

Goals: The authors aimed to characterize older adults’ intentions for future surveillance colonoscopy, knowledge of polyps, and predictors of colonoscopy plans. Background: Guidelines recommend that the decision to continue or stop surveillance colonoscopy in older adults with colon polyps be “individualized.” Although older adults want to be included in decision making, how knowledge regarding polyps influences decisions is unknown. Study: In collaboration with a rural family medicine practice, the authors invited adults aged 65 years and older with a history of colon adenomas to complete a 14-item survey regarding intention for colonoscopy and knowledge of colon polyps. Results: Sixty-seven of 105 (63%) patients completed the survey. The mean age was 72 years. Regarding future surveillance, 53% planned to return, 25% were unsure, and 22% did not plan to return. There were no significant differences in baseline characteristics on the basis of the intention for future colonoscopy. Regarding polyp knowledge, 73% had correct knowledge around how common polyps are; 50% thought that more than half of untreated polyps would become cancerous—an inaccurately elevated perception by 10 folds. Respondents who perceived polyps to have a high malignant potential were more likely to report plans for surveillance colonoscopy (68% vs. 39%; P=0.03). Conclusions: In this survey of older adults with a history of polyps, many had a falsely elevated perception of polyps’ potential for cancer that was associated with a higher intention for future colonoscopy. Ensuring older adults have an understanding of the risks of polyps is an essential step toward improving decision making around surveillance colonoscopy.

Health utility assessments in individuals undergoing diagnostic and surveillance colonoscopy: improved discrimination with a cancer-specific scale

“…Polyps were not divided into subclasses (e.g., advanced or non-advanced adenomas, sessile-serrated lesions, benign polyps) as it was felt that this level of discrimination would not be appropriate for most individuals. Patients’ pathology knowledge is often limited to whether anything was found and removed at colonoscopy, and whether it was cancer [ 24 , 25 ].…”