title: Provider recommendations for colorectal cancer screening in elderly veterans.
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
  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.
  
  
  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.
authors.affiliation: Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 1481 W 10th street C-7055, Indianapolis, IN 46202, USA. ckahi2@iupui.edu
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Kahi
authors.forename: Michelle
authors.initials: M
authors.lastname: van Ryn
authors.forename: Beth
authors.initials: B
authors.lastname: Juliar
authors.forename: Jennifer Schaffter
authors.initials: JS
authors.lastname: Stuart
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Imperiale
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D015897:Comorbidity / Q000639:trends; D055088:Early Detection of Cancer / Q000379:methods* / Q000639:trends; D005260:Female; D006287:Health Planning Guidelines; D006787:Hospitals, Veterans / Q000639:trends; D006801:Humans; D008017:Life Expectancy / Q000639:trends; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010818:Practice Patterns, Physicians' / Q000639:trends; D011795:Surveys and Questionnaires; D014481:United States; D014728:Veterans