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Colon Cancer Screening for Older Adults

For adults ages 45 to 75, it is recommended to do routine screening for colorectal cancer — also called colon cancer — or for polyps, abnormal growths that may turn into cancer over time. Regular screening is one of the best ways to identify colon cancer in an earlier stage when it is easiest to treat. Furthermore, because almost all colon cancers begin as polyps, finding polyps and removing them before they have a chance to turn into cancer is even better. 

However, current clinical guidelines note that the benefits of screening for colon cancer in older adults — those ages 76-85 — may not outweigh the harms, potentially leaving many older adults wondering: How do I know if I should be screened or not? For this reason, it is recommended clinicians work together with patients to make screening decisions that work best for each patient. This is known as shared decision making.

Testing Clinician Options to Support Patients

One PCORI-funded study sought to compare two approaches for clinicians to help their individual patients make an informed decision. In one approach, clinicians received an electronic email or alert in a patient's electronic health record two to three days before meeting with them. This alert encouraged them to discuss colorectal cancer screening with their patients. In the other approach, clinicians received that same alert, but also completed a two-hour, online training. This training focused on shared decision making — a collaborative process between a clinician and their patient working together to reach a joint decision about care — with examples of how to talk with their patients about whether colon cancer screening was right for them. The research team designing this study included patients, advocacy groups and clinicians. 

Results showed that patients whose clinicians completed the online training in addition to receiving the electronic alerts to discuss screenings with them were more likely to report more shared decision making, were more likely to discuss colon cancer with their clinician and had more intention to follow through with the screening of their choice. The patients whose clinicians completed the additional training in shared decision making also more likely to have a routine screening over the course of the year.

This model including clinician training in shared decision making shows promise as one that might be applied to other health decisions, as well.

A Promising Model for Shared Decision Making

In cases like these, where the decision to be made is as unique as each patient facing it, shared decision making is of the utmost importance. This model including clinician training in shared decision making shows promise as one that might be applied to other health decisions, as well.

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