Physician training in communication skills increased shared decision making and discussions about whether to continue screening for colorectal cancer (CRC) in elderly primary care patients, a study found.
The U.S. Preventive Services Task Force recommends that clinicians selectively offer CRC screening in patients ages 76 to 85 years and that patients and clinicians should consider patients' overall health, screening history, and preferences when determining whether screening is appropriate. Researchers performed a two-arm, multisite cluster randomized trial at five academic and community hospital networks in the Northeastern U.S. to determine whether training and electronic reminders would help increase shared decision making around CRC screening in this age group. (Of note, ACP's 2019 guidance statement on CRC screening in asymptomatic average-risk adults states that clinicians should discontinue screening for colorectal cancer in average-risk adults >75 years or in adults with a life expectancy of ≤10 years. )
Internal medicine and family medicine physicians assigned to the intervention arm completed a two-hour online course in communication skills for shared decision making and received an email or EHR reminder to have a conversation with the patient about whether to continue CRC testing. Those assigned to the comparator arm received reminders only. The study results were published Aug. 5 by the Journal of General Internal Medicine.
Sixty-seven physicians were enrolled in the study, 34 in the intervention arm and 33 in the comparator arm. Among the 466 patients, 236 in the intervention arm and 230 in the comparator arm, the average age was 79 years, 50% self-rated their health as excellent or very good, and 66% had had at least one previous colonoscopy. Patients in the intervention arm had higher scores on the Shared Decision-Making Process (adjusted mean difference, 0.36 [95% CI, 0.08 to 0.64]; P=0.01) than those in the comparator arm. In addition, more patients in the intervention arm said they had discussed CRC screening during their visit (72% vs. 60%; P=0.03) and had greater intentions to follow through with their preferred care approach (58.0% vs. 47.1%; P=0.03). No significant differences were seen in knowledge about CRC screening and visit satisfaction between arms.
The authors noted that 60% of the study took place during the COVID-19 pandemic, when care was disrupted, and that racial and ethnic diversity among the patient sample was limited, among other limitations. They concluded that while absolute scores for shared decision making in both study arms remained low, physicians who received brief training on shared decision making were more likely to have discussions with elderly patients about whether to continue CRC screening than those who received email or EHR reminders alone. They called for future studies to look at the role of patient decision aids and other clinic staff in discussions about continuing screening. “Just as patients deserve thoughtful conversations about when and how to start cancer screening in mid-life, it is time for explicit, nuanced conversations with patients about the completion of cancer screening in later life,” the authors wrote.