Physicians' decisions about continuing or stopping colon cancer screening in the elderly: a qualitative study.
BACKGROUND
Experts suggest an individualized approach to colon cancer screening to take into account variation in older adults' life expectancies and potential to benefit from screening. However, little is known about how physicians make decisions about colon cancer screening in adults age 75 and older.


OBJECTIVE
To understand whether physicians employ individualized decision making for colon cancer screening in older adults, and, if so, to determine the individual factors they believed were important to consider in making such decisions.


METHODS
Qualitative research using focus groups and individual interviews


METHODS
Fifteen primary care physicians practicing in community settings participated in three focus groups and two interviews.


METHODS
We used two clinical vignettes of 78-year-old women in fair and poor health states to stimulate discussions about clinical decision making for CRC screening in older adults.


RESULTS
Physicians considered a wide range of factors, including clinical factors, such as age, life expectancy, co-morbidities, and functional status, as well as individual factors, such as personality, previous screening behavior, family support, and the relationship with the patient. Physicians reported difficulty with these decisions because of their complexity and because they involve life expectancy estimates. Their approach and discussion with patients seemed to be dependent on the degree of certainty they perceived regarding their clinical assessment as to whether the patient had the potential to benefit from screening.


CONCLUSIONS
Colorectal cancer screening decision making is complex. Physicians reported using a range of clinical and individual factors to decide about colorectal cancer screening in older adults.
Division of General Internal Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill, NC, USA. Carmen_Lewis@med.unc.edu
Carmen L
CL
Lewis
Jennifer
J
Griffith
Michael P
MP
Pignone
Carol
C
Golin
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer; D005260:Female; D017144:Focus Groups; D015577:Geriatric Assessment; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D008962:Models, Theoretical; D009657:North Carolina; D010819:Physician's Role; D010820:Physicians; D010818:Practice Patterns, Physicians'; D036301:Qualitative Research; D012938:Social Perception