Resident Physicians' Life Expectancy Estimates and Colon Cancer Screening Recommendations in Elderly Patients

Abstract

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. Purpose. 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.

Keywords

decision making aged aged 80 and older mass screening colorectal cancer.

Get full access to this article

View all access options for this article.

References

Hardcastle JD , Chamberlain JO , Robinson MH , et al. Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet. 1996 ;348(9040):1472-7.

Kronborg O. , Fenger C. , Olsen J. , Jorgensen OD , Sondergaard O. Randomised study of screening for colorectal cancer with faecal-occult-blood test. Lancet. 1996;348(9040):1467-71.

Mandel JS , Bond JH , Church TR , et al. Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. N Engl J Med. 1993;328(19):1365-71.

Selby JV , Friedman GD , Quesenberry CP Jr , Weiss NS A case-control study of screening sigmoidoscopy and mortality from colorectal cancer. N Engl J Med. 1992;326(10):653-7.

Thiis-Evensen E. , Hoff GS , Sauar J. , Langmark F. , Majak BM , Vatn MH Population-based surveillance by colonoscopy: effect on the incidence of colorectal cancer. Telemark Polyp Study I. Scand J Gastroenterol. 1999;34(4):414-20.

Winawer SJ , Flehinger BJ , Schottenfeld D. , Miller DG Screening for colorectal cancer with fecal occult blood testing and sigmoidoscopy . J Natl Cancer Inst. 1993;85(16):1311-8.

Winawer SJ , Zauber AG , Ho MN , et al. Prevention of colorectal cancer by colonoscopic polypectomy . The National Polyp Study Workgroup. N Engl J Med. 1993;329(27):1977-81.

Walter LC , Lewis CL , Barton MB Screening for colorectal, breast, and cervical cancer in the elderly: a review of the evidence. Am J Med. 2005;118(10):1078-86.

AGS Position Paper: Health screening decisions for older adults. Available from: URL: http://www.americangeriatrics.org/products/positionpapers/stopscreening.shtml . Accesed 20 January 2003.

10.

Walter LC , Covinsky KE Cancer screening in elderly patients: a framework for individualized decision making. JAMA. 2001;285(21):2750-6.

11.

Welch HG , Albertsen PC , Nease RF , Bubolz TA , Wasson JH Estimating treatment benefits for the elderly: the effect of competing risks . Ann Intern Med. 1996;124(6):577-84.

12.

Flaherty JH , Morley JE , Murphy DJ , Wasserman MR The development of outpatient Clinical Glidepaths . J Am Geriatr Soc. 2002;50(11):1886-901.

13.

American Cancer Society. ACS cancer detection guidelines. Available from: URL: http://www.cancer.org/docroot/PED/content/PED_2_3X_ACS_Cancer_Detection_Guidelines_36.asp . Accessed 8 May 2003.

14.

Heflin MT , Oddone EZ , Pieper CF , Burchett BM , Cohen HJ The effect of comorbid illness on receipt of cancer screening by older people . J Am Geriatr Soc. 2002;50(10):1651-8.

15.

Cooper GS , Fortinsky RH , Hapke R. , Landefeld CS Primary care physician recommendations for colorectal cancer screening: patient and practitioner factors. Arch Intern Med. 1997;157(17): 1946-50.

16.

Burack RC , George J. , Gurney JG Mammography use among women as a function of age and patient involvement in decision-making. J Am Geriatr Soc. 2000;48(7):817-21.

17.

Kiefe CI , Funkhouser E. , Fouad MN , May DS Chronic disease as a barrier to breast and cervical cancer screening. J Gen Intern Med. 1998;13(6):357-65.

18.

Christakis NA , Lamont EB Extent and determinants of error in doctors' prognoses in terminally ill patients: prospective cohort study. BMJ. 2000;320(7233):469-72.

19.

Everitt B. The Analysis of Contingency Tables. 2nd ed. London: King's College; 1977.

20.

Maxwell AE Comparing the classification of subjects by two independent judges. Br J Psychiatry. 1970;116(535):651-5.

21.

Stuart AA A test for homogeneity of the marginal distributions in a two-way classification . Biometrika. 1955;42:412-6.

22.

Uebersax J. User guide for the MH program (version 1.1). Available from: Statistical Methods for Rater Agreement Web site. 2006.

23.

Zhang J. , Yu KF What's the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. JAMA. 1998;280(19):1690-1.

24.

Vigano A. , Dorgan M. , Bruera E. , Suarez-Almazor ME The relative accuracy of the clinical estimation of the duration of life for patients with end of life cancer. Cancer. 1999;86(1):170-6.

25.

Poses RM , Krueger JI , Sloman S. , Elstein AS Physicians' judgments of survival after medical management and mortality risk reduction due to revascularization procedures for patients with coronary artery disease. Chest. 2002;122(1):122-33.

26.

Smith WR , Poses RM , McClish DK , et al. Prognostic judgments and triage decisions for patients with acute congestive heart failure. Chest. 2002 ;121(5):1610-7.

27.

Screening for colorectal cancer: recommendation and rationale . Ann Intern Med. 2002;137(2):129-31.

28.

Heflin MT , Pollak KI , Kuchibhatla MN , Branch LG , Oddone EZ The impact of health status on physicians' intentions to offer cancer screening to older women. J Gerontol A Biol Sci Med Sci. 2006;61(8):844-50.

29.

Walter LC , Lindquist K. , Covinsky KE Relationship between health status and use of screening mammography and Papanicolaou smears among women older than 70 years of age. Ann Intern Med. 2004;140(9):681-8.

30.

Redelmeier DA , Koehler DJ , Liberman V. , Tversky A. Probability judgement in medicine: discounting unspecified possibilities. Med Decis Making. 1995;15(3):227-30.

31.

Poses RM , McClish DK , Smith WR , et al. Physicians' judgments of the risks of cardiac procedures: differences between cardiologists and other internists. Med Care. 1997;35(6):603-17.

32.

Reyna VF , Lloyd FJ Physician decision making and cardiac risk: effects of knowledge, risk perception, risk tolerance, and fuzzy processing. J Exp Psychol Appl. 2006;12(3):179-95.

33.

Peabody JW , Luck J. , Glassman P. , Dresselhaus TR , Lee M. Comparison of vignettes, standardized patients, and chart abstraction: a prospective validation study of 3 methods for measuring quality. JAMA . 2000;283(13):1715-22.

34.

Dresselhaus TR , Peabody JW , Lee M. , Wang MM , Luck J. Measuring compliance with preventive care guidelines: standardized patients, clinical vignettes, and the medical record . J Gen Intern Med. 2000;15(11):782-8.