Preference for CRC Testing Associated With Anticipated Decision Regret, Medical Maximizing

Adults aged 76 to 85 years were more likely to continue testing for colorectal cancer (CRC) due to medical maximizing or anticipated decision regret, with more adults expressing visitor satisfaction after discussing testing. The study published in Patient Education and Counseling could affect the way that clinicians approach testing for CRC in the older adult population.

The US Preventive Services Task Force has previously recommended that testing for CRC should be done on a case-by-case basis for adults aged 76 to 85 years.² This can be determined through a physician’s decision or patient discretion. The methods of testing for CRC are varied, with stool tests and colonoscopies the most used testing methods. However, the performance of each test is varied and can be detrimental to the health of older adults. Older adults could stop testing for CRC and focus on other aspects of their health instead, but shared decision-making should be undertaken to determine whether the adult could benefit from continued testing. This study aimed to assess how patient-provider communication, among other factors, related to the preference of stopping or continuing testing for CRC in older adults aged 76 to 85 years and satisfaction with their medical visit after testing was discussed.¹

Data from the PRIMED study were used in this analysis, which was a study that assigned primary care physicians to receive training on shared decision-making and reminders to older adults who were due for a test. Eligible patients were those aged 76 to 85 years who were recruited from 5 academic and community hospitals in the New England region of the US. All patients were enrolled between October 2019 and September 2020. All patients due for either CRC or surveillance testing and who had a non-urgent visit with a participating physician were eligible for the study.

Older adults reported high visit satisfaction after discussing screening for CRC | Image credit: rocketclips - stock.adobe.com

The primary outcome of the study was preference for continuing testing for CRC, which was determined by asking patients what they believed was the best option for them. Patient satisfaction was the secondary outcome, measured by the response to the patients being questioned about how satisfied they were with the visit. Patients were also asked how much time they spent talking about testing, whether they discussed no further testing, how much they talked about reasons not to test, knowledge about CRC recommendations for older adults, and whether complications of colonoscopy were discussed. Anticipated decision regret about screening, medical maximizing-minimizing preferences, health literacy, sociodemographic factors, and risk attitudes were also evaluated in patients.

There were 375 patients included in this study, of which 251 had data on visit satisfaction. A total of 94% of the participants were White, and 52% had a 4-year college degree or higher education. Continued testing was preferred by 74% of the patients, with 57.7% preferring stool-based tests. A total of 26% preferred no further testing. A total of 63% of the patients reported being extremely satisfied with their visit to their physician.

Patients were more likely to prefer continued testing if they preferred maximizing health care (b, 0.18; P = .048). They also were more likely to have higher anticipated regret at missing a diagnosis (b, 1.02; P < .01) and lower anticipated regret about complications from colonoscopy (b, –0.55; P < .01). Satisfaction with the medical visit was only associated with time spent discussing testing options for CRC (b, 0.68; P < .01).

There were some limitations to this study. The data were collected during the COVID-19 pandemic which could affect care disruptions. The sample of patients was not diverse geographically or racially, with high educational attainment, which could affect the results. The participating physicians could have been more proactive in discussing screening with patients knowing that the study was about screening for CRC. CRC screening tests and CRC surveillance tests were not distinguished in the study.

The researchers concluded that more time spent discussing testing options for CRC led to greater satisfaction in the visitors. Adults were more likely to prefer to continue testing for CRC if they anticipated decision regret and had a preference for medical maximizing. Continuing to give older adults information about screening can eliminate any decision regrets and help them continue to make the best decisions for them.

References

1. Langford AT, Valentine K, Simmons LH, Fairfield KM, Sepucha K. Role of patient-provider communication on older adults’ preferences for continuing colorectal cancer testing and visit satisfaction. Patient Educ Couns. 2025;130:108452. doi:10.1016/j.pec.2024.108452
2. Colorectal cancer: screening. U.S. Preventive Services Task Force. May 18, 2021. Accessed October 1, 2024. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening