Preference for CRC testing associated with expected decision regret and medical maximization

Adults aged 76 to 85 were more likely to continue testing for colorectal cancer (CRC) due to medical maximization or anticipated regret about the decision, with more adults expressing satisfaction with visitors after talking about testing. Study published in Education and counseling for patients may have implications for how clinicians approach CRC testing in the elderly population.

The U.S. Preventive Services Task Force previously recommended that CRC testing be done on an individual basis for adults ages 76 to 85.² This may be determined at the discretion of the physician or at the discretion of the patient. CRC testing methods vary, with the most commonly used methods being stool testing and colonoscopy. However, the effectiveness of each test varies and may be harmful to the health of older people. Older adults may choose to stop testing for CRC and instead focus on other aspects of their health, but shared decision-making should be undertaken to determine whether an adult may benefit from continuing testing. The purpose of this study was to evaluate how patient-caregiver communication, among other factors, is associated with preference to discontinue or continue CRC testing in older adults aged 76 to 85 years and satisfaction with the posttesting medical visit.¹

The analysis used data from the PRIMED study, in which primary care physicians were trained in shared decision-making and reminders to older adults who were about to enter the study. Eligible patients were 76 to 85 years of age and recruited from 5 academic and community hospitals in the New England region of the United States. All patients were enrolled in the study between October 2019 and September 2020. All patients scheduled for CRC or observational studies who had a nonurgent visit to a participating physician were eligible for the study.

The primary outcome of the study was preference for continuing CRC testing, which was determined by asking patients what they thought was the best option for them. Patient satisfaction was a secondary endpoint, measured by responses to patients’ questions about their satisfaction with their visit. Patients were also asked how much time they spent talking about testing, whether they discussed stopping further testing, how often they talked about reasons not to undergo testing, knowledge of CRC recommendations for older adults, and whether complications of colonoscopy were discussed. Patients’ expected regret regarding the screening decision, maximizing-minimizing preferences, health literacy, sociodemographic factors, and risk attitudes were also assessed.

375 patients were included in the study, of which 251 had data on visit satisfaction. A total of 94% of participants were white and 52% had a four-year college degree or higher. 74% of patients preferred continuing testing, and 57.7% preferred stool testing. A total of 26% chose not to continue testing. A total of 63% of patients said they were very satisfied with their visit to the doctor.

Patients were more likely to prefer continued testing if they preferred to maximize health care (b, 0.18; P = 0.048). They were also more likely to experience greater anticipated regret due to missing the diagnosis (b, 1.02; P PP

This study had some limitations. Data was collected during the Covid-19 pandemic, which may result in disruptions to care. The patient sample was not geographically or racially diverse and had high levels of education, which may have influenced the results. Physicians in the study may have been more proactive in discussing screening with patients knowing that the study was about CRC screening. The study did not distinguish between CRC screening and CRC surveillance testing.

The researchers concluded that more time spent discussing CRC testing options resulted in higher visitor satisfaction. Adults were more likely to prefer to continue testing for CRC if they expected to regret the decision and preferred to maximize treatment. Continuing to provide older adults with information about screening can prevent any regrets and help them continue to make the decisions that are best for them.

Reference

1. Langford AT, Valentine K, Simmons LH, Fairfield KM, Sepucha K. The role of patient-provider communication on older adults’ preferences for continuing colorectal cancer testing and visit satisfaction. Patient education counters. 2025;130:108452. doi:10.1016/j.pec.2024.108452
2. Colorectal cancer: screening. United States Preventive Services Task Force. May 18, 2021. Accessed: October 1, 2024.