INFLUENCES ON PRIMARY CARE PROVIDERS' RECOMMENDATIONS FOR HYPOTHETICAL PROSTATE AND COLON CANCER SCREENING IN OLDER ADULTS: A WITHIN-SUBJECTS EXPERIMENT
Title: Influences on Primary Care Providers' Recommendations for Hypothetical Prostate and Colon Cancer Screening in Older Adults: a Within-subjects Experiment
Abstract (word count max 375)- currently 283
Purpose: To identify factors that influence primary care providers' recommendations for cancer screening in older adults.
Methods: A cross-sectional survey of all primary care providers (n=123) in a Research Consortium of 24 primary care Family Medicine and General Internal Medicine clinics in central North Carolina. We designed a within-subjects experiment in which providers read two hypothetical patient vignettes that varied by type of cancer screening test (prostate and colorectal) and were asked whether they would recommend screening for patients that varied by age (age 50, 70, 90) and request for screening (request and no request). Outcomes were providers' recommendations for cancer screening.
Results: We found 51% (95% CI 48%, 54%) would recommend cancer screening, regardless of screening test type, patient age, or patient request. Providers reported they would recommend screening more often for colorectal cancer as compared to prostate cancer (p<0.001) and for younger patients as compared to older patients (p>0.001) Providers said they would recommend screening more often when the patient requested it as compared to when patients made no request for screening, for both vignettes (prostate and colorectal cancer screening) across all ages (p<0.001). The recommendation for screening of hypothetical younger patients was more pronounced for colorectal cancer screening as compared to prostate cancer screening (p<0.001 for the interaction of age on the relationship between screening test and recommendation). The interaction of age on the relationship between patient request and recommendation approached statistical significance (p=0.08).
Conclusions: Providers' reported recommendations for cancer screening depended on type of hypothetical patient being screened. Colorectal cancer screening, younger age, and patient request all increased providers' recommendations. Next steps may include the development of interventions to address screening for prostate cancer, older adults, or patient request.