Provider Recommendations for Colorectal Cancer Screening in Elderly Veterans

  • Charles J. Kahi
  • Michelle van Ryn
  • Beth Juliar
  • Jennifer Schaffter Stuart
  • Thomas F. Imperiale
Original Article

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.

KEY WORDS

screening colorectal cancer aged 

Notes

Acknowledgments

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

Conflict of Interest Summary

None disclosed.

Supplementary material

11606_2009_1110_MOESM1_ESM.doc (125 kb)
Online Appendix (DOC 125 KB)

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Copyright information

© Society of General Internal Medicine 2009

Authors and Affiliations

  • Charles J. Kahi
    • 1
    • 6
  • Michelle van Ryn
    • 3
  • Beth Juliar
    • 4
  • Jennifer Schaffter Stuart
    • 2
  • Thomas F. Imperiale
    • 1
    • 5
  1. 1.Department of Medicine, Division of Gastroenterology and HepatologyIndiana University School of MedicineIndianapolisUSA
  2. 2.The Richard L. Roudebush VA Medical CenterIndianapolisUSA
  3. 3.Department of Family Medicine and Community HealthUniversity of Minnesota Medical SchoolMinneapolisUSA
  4. 4.Department of BiostatisticsIndiana UniversityIndianapolisUSA
  5. 5.Regenstrief Institute, Inc.IndianapolisUSA
  6. 6.GastroenterologyRoudebush VAMCIndianapolisUSA

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