Longer PCP discussion may boost CRC screening, concordance rates among older adults
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Key takeaways:
- At 12 months, 39% of those in the intervention group and 29% in the comparator group completed CRC screening.
- Approximately 51% vs. 46%, respectively, received their preferred screening approach.
Although training primary care providers in shared decision-making did not significantly improve colorectal cancer concordance or screening rates in older adults, at least 5 minutes of discussion with a PCP may benefit some, data showed.
“The Promoting Informed Decisions About Colorectal Cancer Screening in Older Adults (PRIMED) study evaluated the effect of an online [shared decision-making (SDM)] training course for primary care physicians plus electronic reminders sent before visits with older adults who were due for discussion about CRC screening or surveillance testing,” Karen R. Sepucha, PhD, of the division of general internal medicine at Massachusetts General Hospital, and colleagues wrote in JAMA Network Open.
“As reported previously, the PRIMED investigators found that patients seen by physicians in the training group reported more frequent discussions about CRC testing, had higher SDM scores and expressed greater intentions to follow through with their preferred approach.”
In a secondary analysis of the PRIMED trial, Sepucha and colleagues compared physician training in SDM combined with electronic reminders (intervention) vs. reminders alone (comparator) on concordance, defined as the proportion of older adult patients who followed through with their preferred CRC screening modality, as well as overall screening rates at 12 months.
The researchers enrolled 59 PCPs (mean age, 52.7 years; 50.8% women), of whom 16 had previous SDM training, and 466 older adults (mean age, 80.3 years; 53.4% women) who were overdue for CRC screening. Participants were randomly assigned to intervention (PCPs, n = 28; older adults, n = 236) and comparator (PCPs, n = 31; older adults, n = 230) arms.
Overall, patients’ preferred CRC screening methods were stool-based tests (34.5%) and colonoscopy (24.8%), while 20.8% preferred no further screening and 16.1% reported being unsure. The remainder (3.6%) did not indicate a preference and were excluded from analysis.
Researchers observed similar test uptake at 12 months between intervention and comparator arms for colonoscopy (12.3% vs. 13.9%), stool-based tests (26.3% vs. 15.2%) and no testing (61.4% vs. 70.9%). Concordance was higher in the intervention arm (50.9% vs. 46.2%), but the difference did not reach statistical significance (4.7%; adjusted OR = 1.17; 95% CI, 0.78-1.78).
Further, results from heterogeneity analyses demonstrated “significantly higher rates” of concordance in intervention vs. comparator arms among patients who reported more than 5 minutes of discussion with their PCP (aOR = 3.27; 95% CI, 1.25-8.59), as well strong follow-through intention (aOR = 1.79; 95% CI, 1.11-2.89). And while not significant, researchers also observed higher screening rates among patients who reported 2 to 5 minutes of discussion with their PCP (aOR = 1.89; 95% CI, 0.93-3.84).
“With an aging population, having good conversations about whether or when to stop cancer screening is increasingly important,” Sepucha and colleagues wrote. “Furthermore, it appears that reducing the intensity of testing and discussing alternatives to colonoscopy, even for patients with prior experience with colonoscopy, may be acceptable to physicians and patients alike.”
They continued: “Although the SDM training intervention did not make a statistically significant improvement in concordance in this sample, future work to refine and evaluate clinical decision support, as well as focused SDM skills training for PCPs, may promote high-quality, preference-concordant decisions about CRC testing for older adults.”
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