Dartmouth-Hitchcock Medical Center Lebanon, NH, United States
Audrey H. Calderwood, MD, MS, FACG1, Danielle C. Schubbe, BA2, Peter Scalia, PhD2, Stephen K. Liu, MD, MS1, Marie-Anne Durand, PhD, MSc, MPhil3 1Dartmouth-Hitchcock Medical Center, Lebanon, NH; 2The Dartmouth Institute, Lebanon, NH; 3The Dartmouth Institute, Lebanon, NV
Introduction: The complexities of pursuing surveillance colonoscopy become especially important in older adults. The potential harms increase with age and benefits may be uncertain. There is a critical gap in the communication around surveillance in older adults. Our aims were to (1) create an encounter conversation aid (CA) addressing the benefits, harms, and tradeoffs of surveillance colonoscopy for older adults, and (2) user test and assess implementation factors with stakeholder groups to determine its utility, acceptability, and sustainability.
Methods: Existing evidence on risks of colorectal cancer based on polyp history in older adults (≥70), harms of colonoscopy, and patient attitudes toward stopping or continuing surveillance were used to create the CA. A three-phased approach was used to user test and assess the CA’s implementation. (1) With a semi-structured interview guide based on a user experience framework, we conducted telephone interviews with a purposive sample of older adults for feedback to improve the CA. (2) We conducted two online surveys, one for patients (N=200) and one for PCPs/GIs (N=20 each) about the acceptability of the final CA. (3) PCPs at a single academic medical center used the CA during encounters with a sample of their eligible patients. Pre-encounter surveys and post-encounter interviews were conducted.
Results: We developed an encounter CA addressing the benefits, risks, and tradeoffs around surveillance colonoscopy for older adults. We completed Phase 1 from 6/2020-10/2020. We interviewed 10 adults with a history of colon polyps; mean age was 77.2 years (range 70-83), four were female, nine were Caucasian, eight attained at least some college education, three had Medicaid, and nine reported adequate health literacy. Overall, most participants offered minor suggestions to improve the CA’s content (e.g. adding illustrations); found the content useful, easy to read and understand; and felt the order of questions made sense and provided enough information to make an informed decision with their PCP. We adapted the CA based on feedback and added illustrations (Figure 1). Results of the last two phases will be completed by Fall 2021.
Discussion: A CA to help older adults with colon polyps decide whether or not to undergo surveillance colonoscopy appears usable and acceptable in early testing. Ongoing evaluation of implementation factors will inform its dissemination potential.
Figure: Figure. A novel encounter conversation aid to help older adults and their PCPs make decisions about whether to continue or stop surveillance colonoscopy
Danielle Schubbe indicated no relevant financial relationships.
Peter Scalia indicated no relevant financial relationships.
Stephen Liu indicated no relevant financial relationships.
Marie-Anne Durand: Ebsco health – Consultant.
Audrey H. Calderwood, MD, MS, FACG1, Danielle C. Schubbe, BA2, Peter Scalia, PhD2, Stephen K. Liu, MD, MS1, Marie-Anne Durand, PhD, MSc, MPhil3. P2339 - Development of an Encounter Conversation Aid for Older Adults With Colon Polyps Regarding Surveillance Colonoscopy, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.