Resident physicians' life expectancy estimates and colon cancer screening recommendations in elderly patients.
BACKGROUND
Colon cancer screening recommendations for patients aged 75 years and older should account for variation in older adults' health states, life expectancies, and potential to benefit from screening.


OBJECTIVE
To assess if resident physicians incorporate health state and life expectancy information when making recommendations about colon cancer screening for adults aged 75 years and older.


METHODS
Resident physicians at a university internal medicine program completed a survey in which they made life expectancy estimates and screening recommendations for hypothetical 75- and 85-year-old women patients with good, fair, or poor health states. Outcomes of interest included accuracy of residents' life expectancy estimates (compared with life table data), effect of health state and life expectancy on screening recommendations, and whether providing life table information affected the initial screening recommendation for the 85-year-old hypothetical patients.


RESULTS
Residents' life expectancy estimates demonstrated moderate agreement with life table estimates. Their recommendations for colon cancer screening for the 75-year-old patient vignettes varied appropriately by health state and by their estimates of life expectancy. Receiving information about life expectancy from life tables affected residents' recommendations for one of the three 85-year-old hypothetical patients, the woman in good health. Many resident physicians reported uncertainty about the potential to benefit from screening for each patient scenario.


CONCLUSIONS
Resident physicians appropriately used life expectancy and health state to make colon cancer screening recommendations for older adults. Residents reported substantial uncertainty with regard to the potential benefit of screening.
Lewis
Carmen L
CL
Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill, NC 27599, USA. lewiscl@med.unc.edu
Moore
Charity G
CG
Golin
Carol E
CE
Griffith
Jennifer
J
Tytell-Brenner
Alison
A
Pignone
Michael P
MP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000175:diagnosis*; D003657:Decision Making; D005260:Female; D006304:Health Status; D006801:Humans; D007396:Internship and Residency; D008017:Life Expectancy; D008297:Male; D008403:Mass Screening