Abstract
BackgroundCompeting causes of mortality in the elderly decrease the potential net benefit from colorectal cancer screening and increase the likelihood of potential harms. Individualized decision making has been recommended, so that the elderly can decide whether or not to undergo colorectal cancer (CRC) screening. The objective is to develop and test a decision aid designed to promote individualized colorectal cancer screening decision making for adults age 75 and over.MethodsWe used formative research and cognitive testing to develop and refine the decision aid. We then tested the decision aid in an uncontrolled trial. The primary outcome was the proportion of patients who were prepared to make an individualized decision, defined a priori as having adequate knowledge (10/15 questions correct) and clear values (25 or less on values clarity subscale of decisional conflict scale). Secondary outcomes included overall score on the decisional conflict scale, and preferences for undergoing screening.ResultsWe enrolled 46 adults in the trial. The decision aid increased the proportion of participants with adequate knowledge from 4% to 52% (p < 0.01) and the proportion prepared to make an individualized decision from 4% to 41% (p < 0.01). The proportion that preferred to undergo CRC screening decreased from 67% to 61% (p = 0. 76); 7 participants (15%) changed screening preference (5 against screening, 2 in favor of screening)ConclusionIn an uncontrolled trial, the elderly participants appeared better prepared to make an individualized decision about whether or not to undergo CRC screening after using the decision aid.
Highlights
Competing causes of mortality in the elderly decrease the potential net benefit from colorectal cancer screening and increase the likelihood of potential harms
Colorectal cancer (CRC) screening is effective in decreasing disease-specific mortality in adults 50- 75 [1,2,3] but evidence about the effectiveness of colorectal cancer (CRC) screening is limited for adults age 75 and older [4,5,6,7]
From indepth interviews with adults age 75 and older [18] we identified a lack of knowledge about both the delayed benefit from screening and the need to make an individualized decision about CRC screening
Summary
Competing causes of mortality in the elderly decrease the potential net benefit from colorectal cancer screening and increase the likelihood of potential harms. Colorectal cancer (CRC) screening is effective in decreasing disease-specific mortality in adults 50- 75 [1,2,3] but evidence about the effectiveness of CRC screening is limited for adults age 75 and older [4,5,6,7]. Extrapolating from trials in younger populations, it appears that factors, such as age and health status (and their effects on life expectancy) are important for determining whether older individuals could realize net benefit from CRC screening. Older adults may be inadequately informed about the potential benefits and harms of cancer screening [16,17], and the elderly may not understand the effect of competing causes of mortality on the net benefit from undergoing screening [18]. Effective interventions to assure that patients are appropriately informed and have considered their personal preferences during colorectal cancer screening decision making are needed to ensure patients receive high-quality, guideline-concordant care
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