Primary care clinicians’ perceptions of colorectal cancer screening tests for older adults

Although colonoscopy is an effective screening test for colorectal cancer (CRC), it is associated with significant risks, especially in older adults. Stool tests are more convenient and accessible and less invasive. How clinicians make decisions about colonoscopy versus stool tests is not well-understood, especially for older patients. This study used semi-structured interviews with primary care clinicians in Maryland to examine how they considered use of stool tests in their older patients. Four major themes were identified: (1) Stool test equivalency – although many clinicians still considered colonoscopy as the test of choice, some considered stool tests equivalent screening options. (2) Reasons for recommending stool tests – clinicians reported preferentially using stool tests in sicker/older patients or those who declined colonoscopy. (3) Stool test overuse – some clinicians reported recommending stool tests for patients for were not recommend any screening. (4) Barriers to use – including lack of familiarity, un-returned stool test kits, concern for accuracy and cost. Though stool tests are increasingly being implemented as part of CRC screening, they are preferentially being used in older and sicker patients. Further research is needed in guiding clinicians to better individualize the use of different colorectal screening tests in older patients. Read full text