Prevalence of colorectal cancer screening test use by test type and age among older adults in the United States

Adam, Emily; White, Mary C.; Shapiro, Jean A.

doi:10.1111/jgs.17890

Cited by 4 publications

(3 citation statements)

References 13 publications

(17 reference statements)

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“…Among CRC screening test options, colonoscopy is the most frequently used CRC screening test and stool-based tests are the second most frequently used [ 35 , 36 ]. FIT is an annual stool-based test that can be completed at home [ 37 ] and the kits have traditionally been offered to patients during in-person primary care visits.…”

Section: Discussionmentioning

confidence: 99%

Modifications in Primary Care Clinics to Continue Colorectal Cancer Screening Promotion During the COVID-19 Pandemic

et al. 2022

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COVID-19 caused significant declines in colorectal cancer (CRC) screening. Health systems and clinics, faced with a new rapidly spreading infectious disease, adapted to maintain patient safety and address the effects of the pandemic on healthcare delivery. This study aimed to understand how CDC-funded Colorectal Cancer Control Program recipients and their partner health systems and clinics may have modified evidence-based intervention (EBI) implementation to promote CRC screening during the COVID-19 pandemic; to identify barriers and facilitators to implementing modifications; and to extract lessons that can be applied to support CRC screening, chronic disease management, and clinic resilience in the face of future public health crises. Nine recipients were selected to reflect the diversity inherent among all CRCCP recipients. Recipient and clinic partner staff answered unique sets of pre-interview questions to inform tailoring of interview guides that were developed using constructs from the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) and Consolidated Framework for Implementation Research (CFIR). The study team then interviewed recipient, health system, and clinic partner staff incorporating pre-interview responses to focus each conversation. We employed a rapid qualitative analysis approach then conducted virtual focus groups with recipient representatives to validate emergent themes. Three modifications that emerged from thematic analysis include: (1) offering mailed fecal immunochemical test (FIT) kits for CRC screening with mail or drop off return; (2) increasing the use of patient education and engagement strategies; and (3) increasing the use of or improving automated patient messaging systems. With improved tracking and automated reminder systems, mailed FIT kits paired with tailored patient education and clear instructions for completing the test could help primary care clinics catch up on the backlog of missed screenings during COVID-19. Future research can assess the effectiveness and cost-effectiveness of offering mailed FIT kits on maintaining or improving CRC screening, especially among people who are medically underserved. Supplementary Information The online version contains supplementary material available at 10.1007/s10900-022-01154-9.

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Section: Discussionmentioning

confidence: 99%

Modifications in Primary Care Clinics to Continue Colorectal Cancer Screening Promotion During the COVID-19 Pandemic

et al. 2022

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“…[5][6][7][8][9] However, national studies show that many older adults who meet guideline criteria for stopping screening continue to be screened. [10][11][12][13][14][15] Since screenings for breast and colorectal cancers are key quality measures for healthcare systems, physician practices, and insurance plans, the use of reminders or alerts within the EMR to enhance cancer screening rates is increasingly common. [16][17][18][19][20] Currently, quality measures follow age-based guidelines; correspondingly, EMR reminders typically prompt screening for patients up to age 75 years.…”

Section: Introductionmentioning

confidence: 99%

“…Other guidelines have shifted to using limited life expectancy (i.e., <10 years) to guide when to stop screening 5–9 . However, national studies show that many older adults who meet guideline criteria for stopping screening continue to be screened 10–15 …”

Section: Introductionmentioning

confidence: 99%

When should electronic medical records reminders for cancer screening stop?—Results from a national physician survey

Schoenborn

Pollack

Boyd

2023

J American Geriatrics Society

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BackgroundMany older adults are screened for breast and colorectal cancers beyond guideline recommended thresholds. Electronic medical record (EMR) reminders are commonly used to prompt cancer screening. Behavioral economics theory suggests that changing the default settings for these reminders can be effective to reduce over‐screening. We examined physician perspectives about acceptable thresholds for stopping EMR cancer screening reminders.MethodsIn a national survey of 1200 primary care physicians (PCP) and 600 gynecologists randomly selected from the AMA Masterfile, we asked physicians to choose whether EMR reminders for cancer screening should stop based on a list of criteria that included age, life expectancy, specific serious illnesses, and functional limitations. Physicians could choose multiple responses. PCPs were randomized to questions about breast or colorectal cancer screening.ResultsA total of 592 physicians participated (adjusted response rate 54.1%). 54.6% chose age and 71.8% chose life expectancy as criteria for stopping EMR reminders; only 30.6% chose functional limitations. Regarding age thresholds, 52.4% chose ages ≤75, 42.0% chose a threshold between 75 and 85, 5.6% would not stop reminders even at age 85. Regarding life expectancy thresholds, 32.0% chose ≥10 years, 53.1% chose a threshold between 5 and 9 years, 14.9% would not stop reminders even when life expectancy is <5 years.ConclusionsWe found that many physicians would continue EMR reminders for cancer screening even in light of older age, limited life expectancy, and functional limitations. This may reflect reluctance to stop cancer screening and/or reluctance to stop EMR reminders so that physicians can retain control to decide for individual patients, for example, to assess patient preference and ability to tolerate treatment. There was consensus for stopping EMR reminders at ages 85+ and <5‐year life expectancy. Interventions that seek to reduce over‐screening by suppressing EMR reminders may be important for these groups but may have limited physician buy‐in outside these thresholds.

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Changes in uptake of stool-based colorectal cancer screening during the Covid-19 pandemic

Miller

Pinsky

2023

Cancer Causes Control

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Prevalence of colorectal cancer screening test use by test type and age among older adults in the United States

Cited by 4 publications

References 13 publications

Modifications in Primary Care Clinics to Continue Colorectal Cancer Screening Promotion During the COVID-19 Pandemic

Modifications in Primary Care Clinics to Continue Colorectal Cancer Screening Promotion During the COVID-19 Pandemic

When should electronic medical records reminders for cancer screening stop?—Results from a national physician survey

Changes in uptake of stool-based colorectal cancer screening during the Covid-19 pandemic

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