PHYSICIANS' LIFE EXPECTANCY ESTIMATES AND COLON CANCER SCREENING RECOMMENDATIONS IN ELDERLY PATIENTS

BACKGROUND: The life expectancy necessary to realize a potential benefit from colon cancer screening is thought to be at least 5 years (because colon cancer is relatively slow growing). It is unclear whether physicians can successfully use life expectancy in making colon cancer screening decisions for elderly patients. The purpose of this study is to assess physiciansx life expectancy estimates and colon cancer screening recommendations for elderly women in three health states.

METHODS: A random sample of primary care physicians from the AMA Masterfile were surveyed by mail and asked to respond to 3 clinical vignettes of women, aged 80 years, representing patients who have severe, moderate, and mild co-morbidities. Respondents estimated each patient's life expectancy and indicated whether they would recommend colon cancer screening.

RESULTS: To date 268 eligible physicians responded to our questionnaire (47.6% uncorrected response rate).  See Table.

CONCLUSIONS: Physicians' generally underestimated life expectancies for all three vignettes compared to life table estimates. Physicians appear to be less inclined to encourage patient participation in decisions about colon cancer screening as health state worsens. Decision support may be helpful for physicians when confronted with the question of whether to continue screening in their elderly patients.

	Mild % n=256	Moderate % n=257	Severe % n=257
Life expectancy from life table (years)	13	9	5
MD estimates
<2 yrs	<1	8	67
2-5 yrs	7	68	31
6-10 yrs	45	23	2
>10 yrs	47	1	0
would initiate discussion	91	65	42
would not discuss or order test	7	29	54