Appropriate CRC Screening for Older Adults Enhanced By Personalized Information

Older adults who were given detailed, personalized information about benefits and harms of colorectal cancer (CRC) screening immediately before a primary care visit were more likely to receive screening orders consistent with benefit and less likely to utilize screening, according to a study published in JAMA Internal Medicine.

“Despite guideline recommendations, clinicians do not systematically use prior screening or health history to guide CRC screening decisions in older adults,” wrote first author Sameer D. Saini, MD, MS, of the Lieutenant Colonel Charles S. Kettles VA Healthcare System, Ann Arbor, Michigan, and coauthors in the study background.

To investigate the effect of a personalized intervention in older adults, the study included 431 average-risk US veterans, aged 70 to 75 years, attending a primary care visit at a Veterans Affairs facility who were due for average-risk CRC screening. More than 98% were male, 86.8% were White, and 81.4% had undergone prior screening.

Nearly 60% of participants received a detailed decision-aid booklet on screening benefits and harms that was personalized for age, sex, screening history, and comorbidities. The remaining participants, who made up the control group, received a screening information booklet. Additionally, all participants received primary care provider education and system-level modifications that supported personalized screening.

Within 2 weeks of their primary care visit, 62.8% of patients in the intervention group and 65.9% of patients in the control group received screening orders, according to the study.

Among patients in the lowest benefit quartile, the proportion receiving screening orders was lower in the intervention group than in the control group: 59.4% vs 71.1%, the study found. Among patients in the highest benefit quartile, the proportion receiving screening orders was higher in the intervention group than in the control group: 67.6% vs 52.5%.

Overall screening rates at 6 months were 41.1% for intervention patients and 55.9% for control patients, researchers reported.

“Presenting older adults with personalized information about screening benefits and harms has the potential to align screening orders with screening benefit and decrease overall use of screening,” the authors advised.

References:
Saini SD, Lewis CL, Kerr EA, et al. Personalized multilevel intervention for improving appropriate use of colorectal cancer screening in older adults: a cluster randomized clinical trial. JAMA Intern Med. 2023;183(12):1334-1342. doi:10.1001/jamainternmed.2023.5656