Study Finds Mixed Acceptance of Guidelines to Stop Colon Cancer Screening at Age 75
A recent cross-sectional study published in JAMA Network Open explored the acceptability of professional guidelines recommending cessation of colon cancer screening for adults aged 75 and older, particularly among individuals with limited life expectancy. The study aimed to evaluate whether older adults with shorter estimated lifespans are more likely to accept these deimplementation recommendations, which aim to reduce low-value care and associated harms.
Researchers analyzed data from Module 8 of the 2018 wave of the Health and Retirement Study (HRS), a biennial longitudinal cohort study involving approximately 20,000 U.S. adults aged 50 and older. The study included responses from 1,273 participants after excluding those with incomplete data. Respondents were categorized into two groups based on life expectancy: those with limited life expectancy (23.9%) and those with longer life expectancy (76.1%). Life expectancy was estimated using the Lee Index for 10-year mortality.
Participants were asked how acceptable they found the guideline recommending cessation of colon cancer screening after age 75, with response options ranging from "very unacceptable" to "very acceptable."
Overall, a weighted 60.4% of respondents found the guidelines somewhat or very acceptable, while 39.6% rated them somewhat or very unacceptable. Notably, acceptability did not differ significantly between participants with limited life expectancy (39.2% unacceptable) and those with longer life expectancy (39.7% unacceptable).
Subgroup analysis revealed gender-based differences. Among male respondents with limited life expectancy, guideline acceptability was lower, while the opposite pattern was observed among female respondents. In logistic regression analysis, female respondents with limited life expectancy were significantly more likely to find the guidelines acceptable (odds ratio, 1.89; 95% CI, 1.09-3.26).
The findings highlight a complex perception of deimplementation guidelines among older adults. "While many older adults found these guidelines somewhat or very acceptable, a sizable minority did not," the study notes. This lack of differential acceptability between life expectancy groups suggests that shorter expected lifespans do not necessarily increase adherence to recommendations aimed at reducing low-value care.
Reference
Brotzman LE, Zikmund-Fisher BJ, Kerr EA, Kabeto M, Kullgren JT. Acceptability of guidelines to stop colon cancer screening by estimated life expectancy. JAMA Netw Open. Published online December 2, 2024. doi:10.1001/jamanetworkopen.2024.47802
