Examining Generalizability of Older Adults’ Preferences for Discussing Cessation of Screening Colonoscopies in Older Adults with Low Health Literacy

Nancy L. Schoenborn, Norah L. Crossnohere, Ellen Janssen, Craig E. Pollack, Cynthia M. Boyd, Antonio C. Wolff, Qian Li Xue, Jacqueline Massare, Marcela Blinka, John Bridges

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Background/Objectives: Many older adults receive unnecessary screening colonoscopies. We previously conducted a survey using a national online panel to assess older adults’ preferences for how clinicians can discuss stopping screening colonoscopies. We sought to assess the generalizability of those results by comparing them to a sample of older adults with low health literacy. Design: Cross-sectional survey. Setting: Baltimore metropolitan area (low health literacy sample) and a national, probability-based online panel—KnowledgePanel (national sample). Participants: Adults 65+ with low health literacy measured using a single-question screen (low health literacy sample, n = 113) and KnowledgePanel members 65+ who completed survey about colorectal cancer screening (national sample, n = 441). Measurements: The same survey was administered to both groups. Using the best-worst scaling method, we assessed relative preferences for 13 different ways to explain stopping screening colonoscopies. We used conditional logistic regression to quantify the relative preference for each explanation, where a higher preference weight indicates stronger preference. We analyzed each sample separately, then compared the two samples using Spearman’s correlation coefficient, the likelihood ratio test to assess for overall differences between the two sets of preference weights, and the Wald test to assess differences in preference weights for each individual phrases. Results: The responses from the two samples were highly correlated (Spearman’s coefficient 0.92, p < 0.0001). The most preferred phrase to explain stopping screening colonoscopy was “Your other health issues should take priority” in both groups. The three least preferred options were also the same for both groups, with the least preferred being “The doctor does not give an explanation.” The explanation that referred to “quality of life” was more preferred by the low health literacy group whereas explanations that mentioned “unlikely to benefit” and “high risk for harms” were more preferred by the national survey group (all p < 0.001). Conclusion: Among two different populations of older adults with different health literacy levels, the preferred strategies for clinicians to discuss stopping screening colonoscopies were highly correlated. Our results can inform effective communication about stopping screening colonoscopies in older adults across different health literacy levels.

Original languageEnglish (US)
Pages (from-to)2512-2519
Number of pages8
JournalJournal of general internal medicine
Issue number11
StatePublished - Nov 1 2019


  • cancer screening
  • colorectal cancer
  • communication
  • health literacy
  • patient preferences

ASJC Scopus subject areas

  • Internal Medicine


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