Medical Decision Making

 

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This version was published on April 1, 2008
Medical Decision Making, Vol. 28, No. 2, 254-261 (2008)
DOI: 10.1177/0272989X07311756

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

Carmen L. Lewis, MD, MPH

Division of General Medicine and Clinical Epidemiology, University of North Carolina, lewiscl{at}med.unc.edu, Cecil G. Sheps Center for Health Services Research University of North Carolina, Chapel Hill

Charity G. Moore, PhD, MSPH

Cecil G. Sheps Center for Health Services Research University of North Carolina, Chapel Hill

Carol E. Golin, MD, MPH

Division of General Medicine and Clinical Epidemiology, University of North Carolina, Cecil G. Sheps Center for Health Services Research University of North Carolina, Chapel Hill

Jennifer Griffith, DrPH, MPH

Cecil G. Sheps Center for Health Services Research University of North Carolina, Chapel Hill

Alison Tytell-Brenner, BS

Cecil G. Sheps Center for Health Services Research University of North Carolina, Chapel Hill

Michael P. Pignone, MD, MPH

Division of General Medicine and Clinical Epidemiology, University of North Carolina

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.

Key Words: decision making • aged • aged 80 and older • mass screening • colorectal cancer.


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