Provider Perspectives Vary on Surveillance Colonoscopy in Adults Over 75

Decisions about continuing surveillance colonoscopy in adults older than 75 years remain highly individualized and influenced by multiple factors, according to a qualitative study of Veterans Health Administration (VA) providers. The findings highlight variability in clinical practice and underscore the need for clearer guidance.

Investigators conducted 24 semi-structured interviews with primary care providers, gastroenterologists, and geriatricians across two VA sites. Discussions explored patient-, provider-, and system-level factors shaping post-polypectomy surveillance decisions in older adults.

Patient-level considerations included age, life expectancy, comorbidities, and patient preferences. Providers emphasized the importance of aligning surveillance decisions with overall health priorities. One recurring theme was the heterogeneity of older adults, with clinicians noting that some individuals at age 75 “can run a marathon” while others are “bed bound,” reflecting wide variation in functional status.

Provider-level factors also influenced decision-making. Many clinicians reported deferring to gastroenterology recommendations, while others considered whether patients would pursue treatment if malignancy were detected. Approaches to shared decision-making varied, with some providers prioritizing patient preferences and others relying more heavily on clinical judgment.

System-level influences included electronic reminders and resource considerations. Some providers described reminders as “helpful,” while others noted they are “good in principle but have their limitations.” Opinions also differed on the value of continued surveillance, with some citing “poor resource utilization” and others describing ongoing surveillance as “the status quo.”

Reference
Chawla N, Loeb T, Gupta S, et al. Provider perspectives on colorectal cancer surveillance among veterans age 75 and older: the SURVOLDERADULTS (surveillance colonoscopy in older adults) study. Presented at: Digestive Disease Week; May 2–5, 2026; Chicago, Illinois.