Grant Details
| Grant Number: | 5R21CA227776-02 Interpret this number |
| Primary Investigator: | Calderwood, Audrey |
| Organization: | Dartmouth-Hitchcock Clinic |
| Project Title: | Reducing Inappropriate Use of Surveillance Colonoscopy in Older Adults |
| Fiscal Year: | 2020 |
Abstract
Project Summary 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.
Publications
Gaps and improvement opportunities in post-colonoscopy communication.
Authors: Ramirez P.R. , Pineda A.A. , Schultz A.W. , Smith M.M. , Calderwood A.H. .
Source: Techniques And Innovations In Gastrointestinal Endoscopy, 2024; 26(1), p. 90-92.
EPub date: 2023-10-22 00:00:00.0.
PMID: 38515870
Related Citations
Multi-level Factors Influencing Decisions About Stopping Surveillance Colonoscopy in Older Adults: a Qualitative Study.
Authors: Schifferdecker K.E. , Ramesh N.P. , Walter L.C. , Calderwood A.H. .
Source: Journal Of General Internal Medicine, 2023-05-24 00:00:00.0; , .
EPub date: 2023-05-24 00:00:00.0.
PMID: 37225959
Related Citations
Association of Life Expectancy With Surveillance Colonoscopy Findings and Follow-up Recommendations in Older Adults.
Authors: Calderwood A.H. , Tosteson T.D. , Wang Q. , Onega T. , Walter L.C. .
Source: Jama Internal Medicine, 2023-05-01 00:00:00.0; 183(5), p. 426-434.
PMID: 36912828
Related Citations
Yield of Surveillance Colonoscopy in Older Adults with a History of Polyps: A Systematic Review and Meta-Analysis.
Authors: Williams G.J. , Hellerstedt S.T. , Scudder P.N. , Calderwood A.H. .
Source: Digestive Diseases And Sciences, 2022 Aug; 67(8), p. 4059-4069.
EPub date: 2021-08-18 00:00:00.0.
PMID: 34406584
Related Citations
Recommendations for follow-up interval after colonoscopy with inadequate bowel preparation in a national colonoscopy quality registry.
Authors: Calderwood A.H. , Holub J.L. , Greenwald D.A. .
Source: Gastrointestinal Endoscopy, 2022 Feb; 95(2), p. 360-367.e2.
EPub date: 2021-09-23 00:00:00.0.
PMID: 34563501
Related Citations
Colonoscopy utilization and outcomes in older adults: Data from the New Hampshire Colonoscopy Registry.
Authors: Calderwood A.H. , Tosteson T.D. , Walter L.C. , Hua P. , Onega T. .
Source: Journal Of The American Geriatrics Society, 2021-12-03 00:00:00.0; , .
EPub date: 2021-12-03 00:00:00.0.
PMID: 34859887
Related Citations
Representation by Gender of Recognition Award Recipients from Gastroenterology and Hepatology Professional Societies.
Authors: Calderwood A.H. , Roberts J.A. , Silver J.K. , Schmitt C.M. , Enestvedt B.K. .
Source: Journal Of Women's Health (2002), 2021 10; 30(10), p. 1508-1518.
EPub date: 2021-01-12 00:00:00.0.
PMID: 33434440
Related Citations
Impact of the COVID-19 pandemic on utilization of EGD and colonoscopy in the US: An Analysis of the GIQuIC Registry.
Authors: Calderwood A.H. , Calderwood M.S. , Lucas Williams J. , Dominitz J.A. .
Source: Techniques And Innovations In Gastrointestinal Endoscopy, 2021-07-30 00:00:00.0; , .
EPub date: 2021-07-30 00:00:00.0.
PMID: 34345871
Related Citations
Impact of Knowledge and Risk Perceptions on Older Adults' Intention for Surveillance Colonoscopy.
Authors: Calderwood A.H. , Carter C. , Durand M.A. , O'Connor S. , Boardman M. .
Source: Journal Of Clinical Gastroenterology, 2021-07-01 00:00:00.0; 55(6), p. 528-533.
PMID: 32740100
Related Citations
Practice Patterns and Predictors of Stopping Colonoscopy in Older Adults With Colorectal Polyps.
Authors: Rege S. , Coburn E. , Robertson D.J. , Calderwood A.H. .
Source: Clinical Gastroenterology And Hepatology : The Official Clinical Practice Journal Of The American Gastroenterological Association, 2021-06-30 00:00:00.0; , .
EPub date: 2021-06-30 00:00:00.0.
PMID: 34216826
Related Citations
Screening History and Comorbidities Help Refine Stop Ages for Colorectal Cancer Screening.
Authors: Calderwood A.H. .
Source: Clinical Gastroenterology And Hepatology : The Official Clinical Practice Journal Of The American Gastroenterological Association, 2021 03; 19(3), p. 448-450.
EPub date: 2020-07-18 00:00:00.0.
PMID: 32693048
Related Citations
Colorectal Cancer Screening and Surveillance Colonoscopy in Older Adults.
Authors: Maratt J.K. , Calderwood A.H. .
Source: Current Treatment Options In Gastroenterology, 2019 Jun; 17(2), p. 292-302.
PMID: 30969399
Related Citations