Many older adults with a history of colon polyps continue surveillance colonoscopies every 3-5 years to
monitor for recurrent polyps, even after age 75 or when in poor health. There are no explicit guidelines for
when to stop surveillance, unlike there is for when to stop screening for colorectal cancer (CRC). Currently,
approximately 3 million surveillance colonoscopies are performed annually in the US. This number will
double to almost 6 million in the next 6 years as the population ages, rates of CRC screening increase, and
polyp detection improves. At present, there are critical knowledge gaps that hinder the development of
effective strategies to optimize surveillance use in older adults. Most critically, the magnitude of overuse of
surveillance in this aging population has not been fully quantified, nor have the factors that influence patient
and provider decision-making. Therefore, the objective of this study is to create a detailed characterization
of surveillance colonoscopy practice in older adults and to identify current practices and medical decision
making around surveillance. We will capitalize on the unique, NCI-funded longitudinal registry specifically
designed for colonoscopy, the New Hampshire Colonoscopy Registry (NHCR). NHCR prospectively collects
data on nearly 100% of colonoscopies performed in NH and includes detailed colonoscopy information (e.g.
indication, findings, pathology, and endoscopist follow-up recommendations). Specifically, we will link
patients in NHCR to Medicare claims data in order to perform a detailed assessment of the use of
surveillance by life expectancy, identify patients most and least likely to benefit from surveillance based on
surveillance findings and life expectancy, and evaluate provider recommendations for next surveillance
among older adults. We will also conduct semi-structured interviews with patients, gastroenterologists and
primary care providers to identify the multi-level factors involved in the surveillance decision-making
process. At the study conclusion, we will have a detailed understanding of the current practice of
surveillance colonoscopy in older adults with estimates of important clinical outcomes stratified by life
expectancy. Next steps include research to develop and validate multi-level interventions to reduce
inappropriate surveillance colonoscopy use. Our overall goal is to maximize high value care among older
adults while minimizing risks.
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