Piper MS, et al. JAMA Netw Open. 2018;doi:10.1001/JAMAnetworkopen.2018.5461.

December 07, 2018
2 min read

Many patients prefer to continue low-value colonoscopy screenings


Piper MS, et al. JAMA Netw Open. 2018;doi:10.1001/JAMAnetworkopen.2018.5461.

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Sameer Saini

Many patients prefer to not stop undergoing screening colonoscopies even if their doctors believe the benefits of continued screening may be low, according to research published in JAMA Open Network.

“Current [United States Preventative Services Task Force] guidelines recommend an individualized approach to colon cancer screening in adults aged 76 to 85,” Sameer D. Saini, MD, MS, of the Veterans Affairs Health Services Research and Development Service Center for Clinical Management Research, told Healio Gastroenterology and Liver Disease. “We have a growing array of risk calculators to help us make these individualized decisions, but we have a limited understanding of how patients view the use of such calculators in clinical practice.”

To better understand patient attitudes towards screening recommendations, researchers surveyed 1,054 patients older than 50 years who had undergone prior screening with normal results at the V.A. Ann Arbor Healthcare System (median age range 60–69 years; 85.9% white; 94.2% men). The primary measurement was the response to the question, “if you personally had serious health problems that were likely to shorten your life and your doctor did not think screening would be of much benefit based on the calculator, how comfortable would you be with not getting any more screening colonoscopies?”

Based on the survey responses, researchers found that 28.7% of patients were not at all comfortable with ceasing low-value colorectal cancer screening, while 49.3% believed that age should never be used to decide when to stop screening, and 31.7% thought it was not at all reasonable to use life expectancy calculators.

Patients who had higher trust in physicians and who had higher perceived health status were more comfortable with screening cessation (OR = 1.19; 95% CI, 1.07–1.32 and OR = 1.41; 95% CI, 1.23–1.61, respectively). Patients with greater perceived effectiveness of screening and with greater perceived threat of CRC had less comfort with cessation (OR = 0.86; 95% CI, 0.8–0.94 and OR = 0.81; 95% CI, 0.73–0.89, respectively).

“Ultimately, our study suggests that we may face resistance to using a more individualized, benefit-based approach to screening in older adults,” Saini said. “Future studies are needed to help us better understand how to effectively communicate with patients in this context.” – by Alex Young

Disclosures: Saini reported receiving grants from Veterans Affairs Health Services Research and Development during the conduct of the study, memorandum of understanding with Veterans Affairs Clinical Analytics and Reporting, and personal fees from FMS Inc, and Academy Health outside the submitted work. Please see the full study for all other authors’ relevant financial disclosures.