Colorectal cancer (CRC) is a significant health concern, and routine screening is recommended for individuals between the ages of 45 and 75. However, the benefits and risks of screening can vary depending on a patient’s age, health status, and previous screening history. In a recent cluster randomized trial involving U.S. veterans, researchers sought to determine the impact of personalized information on screening orders for CRC. This article analyzes the study and its implications for patient-centered decision-making in CRC screening.
The study included 431 U.S. veterans aged 70 to 75 who were attending a primary care visit at a VA medical center or an outpatient clinic. All participants were at average risk for CRC and were due for screening. The intervention group received a detailed decision-aid booklet personalized to their age, sex, prior screening, and comorbidities. In contrast, the control group received a non-personalized booklet. Both groups received education and support for personalized screening from their primary care physicians. The researchers found that when provided with personalized information, 62.8% of patients in the intervention group received screening orders within two weeks of their visit, compared to 65.9% in the control group. However, the difference was not statistically significant.
A prespecified interaction analysis revealed interesting results regarding the low and high-benefit quartiles. In the low-benefit quartile, the proportion of patients receiving screening orders was lower in the intervention group compared to the control group (59.4% vs. 71.1%). Conversely, in the high-benefit quartile, more patients in the intervention group received screening orders compared to the control group (67.6% vs. 52.2%). Although this interaction was statistically significant, it is important to note that the overall differences were small.
One concerning finding from the study was that fewer patients in the intervention group underwent screening at the 6-month mark compared to the control group (41.4% vs. 55.9%). This suggests that the personalized information may have influenced patients’ decision-making, leading some to opt-out of screening. While it is essential to ensure that patients are well-informed about the benefits and risks of screening, it is equally important to encourage adherence to recommended guidelines for cancer prevention.
The researchers noted that as individuals age and acquire health problems, the benefits of CRC screening decrease, while potential harm increases. However, there is currently no established patient-centered approach to guide both patients and physicians in decision-making when there are competing health issues. Personalized information may play a crucial role in bridging this gap by providing patients with relevant data tailored to their unique circumstances. Further research is needed to develop effective strategies that address the complexities of screening decisions in older adults with varying health conditions.
Dr. Aasma Shaukat from the NYU Grossman School of Medicine commended the study for its educational intervention design. However, she cautioned that the generalizability of the findings to a broader population needs further exploration since the study was conducted only in veterans. Additionally, patients aged 76 and older were not included in the study, making it crucial to investigate the impact of personalized information on screening practices in this age group. Furthermore, it is worth noting that the majority of participants in the study were white men, which may limit the applicability of the findings to more diverse populations.
The use of personalized information in CRC screening orders has shown some potential in aligning screening practices with individual benefits. However, the impact of such interventions appears to differ among patients in the low and high-benefit quartiles. While personalized information can empower patients to make informed decisions about CRC screening, efforts must be made to ensure that patients receive appropriate guidance from healthcare professionals regarding the recommended screening guidelines. As researchers continue to explore patient-centered approaches to screening decisions, it is essential to consider the unique needs and circumstances of older adults with varying health conditions. Ultimately, the goal is to optimize the health outcomes and quality of life for all individuals at risk of developing CRC.