Patients Uncomfortable Stopping Colorectal Cancer Screening Despite Low Value
Ongoing screening colonoscopies may not benefit older adults with comorbidities and limited life expectancy.
Patients who had undergone colorectal cancer screening reported being skeptical about physician-recommended cessation of such screening, even though the testing has not been found to be significantly beneficial for all patients, according to a study published in JAMA Network Open.
A group of US-based researchers deployed a survey to determine how older patients felt about discontinuing low-value colorectal cancer screening, defined as having small benefit based on quantitative estimates from hypothetical risk calculators.
Patients older than age 50 years who were part of the Veterans Affairs Ann Arbor Healthcare system and who had undergone screening colonoscopy with normal results were included in the study.
The primary outcome measured was response to the survey question, “If you personally had serious health problems that were likely to shorten your life, and your doctor did not think screening would be of much benefit based on the calculator, how comfortable would you be with not getting any more screening colonoscopies?”
Of the 1500 surveys mailed to eligible participants, 85 were returned to sender, and 1054 of the remaining surveys were completed; 300 participants indicated that they were not at all comfortable with discontinuing low-value screenings, and 509 participants felt that age should not be a deciding factor to stop screening.
A total of 332 participants believed that life expectancy calculators were not at all reasonable tools to guide such decisions; 255 participants expressed that it was not at all reasonable to use colorectal cancer risk calculators to guide screening-cessation decisions.
The investigators calculated the odds ratio (OR) of factors linked to comfort with screening discontinuation including higher trust in physician (OR, 1.19), higher perceived health status (OR, 1.41), and higher barriers to screening (OR, 1.20).
Greater perceived effectiveness of screening (OR, 0.86) and greater perceived threat of colorectal cancer (OR, 0.81) were factors linked to less comfort with discontinued screening.
“The findings suggest that many veterans have strong preferences against screening cessation, even when given detailed information about why the benefit may be low,” the authors concluded. “Efforts to tailor screening recommendations may be met by resistance unless they are accompanied by efforts to address underlying perceptions about the benefit of screening.”
Piper MS, Maratt JK, Zikmund-Fisher BJ, et al. Patient attitudes toward individualized recommendations to stop low-value colorectal cancer screening. JAMA Netw Open. 2018;1(8):e185461.