Veterans’ Attitudes Towards De-Intensification of Surveillance Colonoscopy for Low-Risk Adenomas

Maratt, Jennifer K.; Lewis, Carmen L.; Saffar, Darcy; Weston, Lauren E.; Myers, Aimee; Piper, Marc S.; Saini, Sameer D.

doi:10.1016/j.cgh.2018.03.029

Cited by 7 publications

(7 citation statements)

References 6 publications

(4 reference statements)

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“…Factors associated with discomfort with stopping surveillance included fear of CRC and increased perceived effectiveness of colonoscopy. Trust in physicians was associated with increased comfort [26]. As previously discussed, physicians are also drivers of inappropriate CRC screening and surveillance.…”

Section: Current Practicementioning

confidence: 82%

“…While data support weighing benefits and harms in older adults and using a personalized approach [15], patients are resistant to screening cessation. Fear of cancer, hope for early detection and treatment, family history, obligation, and reassurance are all factors patients that report for their desire to continue CRC screening [26,41].…”

Section: When To Stop Crc Screening and Surveillancementioning

confidence: 99%

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Colorectal Cancer Screening and Surveillance Colonoscopy in Older Adults

Maratt

Calderwood

2019

Curr Treat Options Gastro

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Purpose of Review-The purpose of this chapter is to highlight current recommendations regarding colorectal cancer (CRC) screening and post-polypectomy surveillance colonoscopy in older adults and to review the available literature in order to help inform decision-making in this age group.Recent Findings-Age is a risk factor for CRC, however, older adults with a history of prior screening are at lower risk for CRC compared to those who have never been screened. Decisionmaking for CRC screening and post-polypectomy surveillance colonoscopy in older adults is complex and several factors including age, screening history, comorbidities, functional status, bowel preparation, prior experiences, preferences, and barriers need to be considered when weighing risks and benefits. Recent guidelines have started to incorporate life expectancy and prior screening history into their recommendations; however, how to incorporate these factors into actual clinical practice is less clear.Summary-There are limited data on the relative benefits of screening and surveillance in older adults and therefore, at this time, decision-making should be individualized and incorporate patient preferences in addition to medical factors.

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Section: Current Practicementioning

confidence: 82%

Section: When To Stop Crc Screening and Surveillancementioning

confidence: 99%

Colorectal Cancer Screening and Surveillance Colonoscopy in Older Adults

Maratt

Calderwood

2019

Curr Treat Options Gastro

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“…Despite our finding that poor health had the largest effect on physicians' recommendations of surveillance colonoscopies, literature on patient perspectives find that patients may not often consider poor health relevant for surveillance colonoscopy decisions. One survey of 345 veterans with low-risk adenomas aged 60–89 years found that almost half were not comfortable with stopping surveillance in the setting of poor health (27). Developing patient-facing materials, communication tools for clinicians, and tools to support shared decision-making about surveillance colonoscopies that engage both physicians and patients are all important next steps.…”

Section: Discussionmentioning

confidence: 99%

Physician Decision-Making About Surveillance in Older Adults With Prior Adenomas: Results From a National Survey

et al. 2023

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INTRODUCTION: There is no clear guidance on when surveillance colonoscopies should stop in older adults with prior adenomas. We aimed to examine physicians' decision-making regarding surveillance colonoscopies in older adults. METHODS:In a national mailed survey of 1,800 primary care physicians (PCP) and 600 gastroenterologists, we asked whether physicians would recommend surveillance colonoscopy in vignettes where we varied patient age (75 and 85 years), health (good, medium, and poor), and prior adenoma risk (low and high).We examined the association between surveillance recommendations and patient and physician characteristics using logistic regression. We also assessed decisional uncertainty, need for decision support, and decision-making roles.

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“…A study of Veterans found that improving health numeracy might help patients accept deimplementation of routine low-value CRC screening 12. In another study, Maratt et al13 surveyed Veterans regarding their attitudes towards less-frequent surveillance or cessation of surveillance for 1 or 2, small, low-risk polyps. They found that higher knowledge regarding the benefits and harms of colonoscopy was associated with more comfort with stopping, whereas worry about CRC was associated with less comfort in stopping 13.…”

Section: Discussionmentioning

confidence: 99%

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

Calderwood

Carter²,

Durand³

et al. 2020

Journal of Clinical Gastroenterology

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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.

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Veterans’ Attitudes Towards De-Intensification of Surveillance Colonoscopy for Low-Risk Adenomas

Cited by 7 publications

References 6 publications

Colorectal Cancer Screening and Surveillance Colonoscopy in Older Adults

Colorectal Cancer Screening and Surveillance Colonoscopy in Older Adults

Physician Decision-Making About Surveillance in Older Adults With Prior Adenomas: Results From a National Survey

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

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