Dr. Simmons and Dr. Sepucha are back for Part 2 of their episode to talk about colorectal cancer screening, and in particular, the importance of individualized decision-making for patients aged 76 to 85. The conversation highlights the challenges faced by clinicians in initiating discussions about continuing or stopping screening, and the importance of patient preferences and goals in guiding these decisions. 

Key Highlights:

About our guests:

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 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.

Key Moments:

5 minutes: 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.”

25 minutes: On how screening shifted modalities due to shared decision-making conversations. “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.”

32 minutes: 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.”

This episode was supported by the Patient Centered Outcomes Research Institute (PCORI) and features 2 studies (Study 1 & Study 2) by Dr. Sepucha & Dr. Simmons.

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