The importance of individualized decision-making for colorectal cancer screening in people aged 76 to 85.
How clinician training prompted an increase in conversations about preferences and options for colorectal cancer screening.
“Can we talk about my options?” or “Here are my goals” as phrases to encourage collaboration between doctor and patient.
About our guests
Dr. Karen Sepucha
Dr. Karen Sepucha is the director of the Health Decision Sciences Center in the Division of General Internal Medicine at Massachusetts General Hospital (MGH) and an associate professor in Medicine at Harvard Medical School. Her research is focused on helping patients and families become meaningfully involved in significant medical decisions. Dr. Sepucha oversees efforts to promote shared decision making in primary and specialty care at MGH and across MassGeneral Brigham Health Care.
Dr. Leigh Simmons
Dr. Leigh Simmons is the Medical Director of the MGH Health Decision Sciences Center where she studies the use of decision aids to help patients and clinicians in the shared decision making process. Dr. Simmons develops and conducts training of physicians and staff in communication skills focused on improving decision making with patients. Her clinical practice is with the Internal Medicine Associates at Massachusetts General Hospital. In addition to her clinical and research interests, Dr. Simmons is a medical student educator and directs the internal medicine clerkship for Harvard Medical School students at Massachusetts General Hospital.
Watch the video of our episode on YouTube
On shared decision-making for colorectal cancer screening in older adults.
The areas that we really think are perfect for shared decision-making are ones where there are real choices. So you can have a colonoscopy, you can have a stool-based test, or you might do neither. I think those are the options that are really on the table for patients in this age group, 76 to 85. So there's not one right answer. It depends on their overall health status, their risk of colon cancer, whether they’ve had polyps in the past, have they had clear colonoscopies. It also depends on what's most important to them. How do they feel about this? So the patient's voice is really critical in figuring out which path is best.
On how screening shifted modalities due to shared decision-making conversations.
In the US colonoscopy really is considered the gold standard. So I think even just understanding that there are options for screening. There is a stool based test option. And what we found, surprisingly, in our study was that we actually increased screening rates. We thought they were going to decrease by giving patients options, but we increased screening rates, but that increase was due to more people doing stool testing.
On tactics to increase collaboration between patients and their healthcare providers.
In decision science, there's two camps. There's the option camp, which is to start with what you can do. And then there's the value camp, which is to start with what you want.
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