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Medicine Grand Rounds - When is Enough, Enough? Decision Making Around Colonoscopy in Older Adults

Dr. Calderwood examines the regional, national and international data analyzing the benefits and harms of screening and surveillance colonoscopies in adults ages 75 and older. Screening and surveillance decisions in this population are complex and should incorporate factors such as co-morbidities, life expectancy, age and polyp history. As potential harm from the procedure increases with age, she suggests reconsidering the current paradigm to develop better communication and decision tools, and identify less invasive strategies that balance benefits and harms.

Activity Details

Start Date:  October 2, 2020
End Date:  October 2, 2023

You may claim CME credit for successful completion of this online course. In order to claim credit, you must follow these steps:

  1. Register for the learning activity by creating an account or logging in to your account.
  2. Click Continue to navigate to the Activity Material tab. Click View Presentation to view the recording. View the entire presentation.
  3. Return to this Activity page.
  4. Click Continue to navigate to the Evaluation tab; then click the Launch button to start the evaluation.
  5. Complete and Submit the evaluation and attestation form.

When the evaluation is submitted, you will be awarded credit. You may access your transcript for verification of participation at any time via Your Account. Need help? Visit the Support Page, send an Email, or call the Center for Learning and Professional Development at (603) 653-1234, Option 1.

Learning Outcome

Participants will be able to review current guidelines regarding screening colonoscopy in older adults, describe the waning benefits and increasing harms of colonoscopy with age and co-morbidities, and discuss non-invasive alternatives to colonoscopy and when to stop screening.

  • Audrey H. Calderwood, MD, MS, FACG, FASGE
    Associate Professor of Medicine and The Dartmouth Institute
    Geisel School of Medicine
    Section of Gastroenterology, Dartmouth-Hitchcock Medical Center

    About our presenter: 
    Dr. Audrey Calderwood has focused on quality as an overarching theme throughout her career. She is passionate about risk-aligned care, such that high-risk patients receive appropriate and timely care and low risk patients avoid unnecessary procedures. She has been highly involved in the American Society of Gastrointestinal Endoscopy, including co-directing a national course on quality in the endoscopy unit that toured throughout the US and co-chairing the multi-society guidelines on safety in the endoscopy unit and infection control in endoscopy. She also serves on the ACG Research Committee and the ACG Women’s Committee.

Dartmouth-Hitchcock is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Dartmouth-Hitchcock designates this enduring material for a maximum of 1 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Requirements for Successful Completion

In order to receive credit for this Continuing Medical Education (CME) activity, you must:

  • View the entire presentation
  • Complete the online Attestation of Attendance & Evaluation Form (you must register to access).

In accordance with the disclosure policy of Dartmouth-Hitchcock/Geisel School of Medicine at Dartmouth as well as standards set forth by the Accreditation Council on Continuing Medical Education and the Nursing Continuing Education Council standards set forth by the American Nurses Credentialing Center Commission on Accreditation, continuing medical education and nursing education activity director(s), planning committee member(s), speaker(s), author(s) or anyone in a position to control the content have been asked to disclose any financial relationship* they have to a commercial interest (any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on patients). Such disclosure is not intended to suggest or condone bias in any presentation, but is elicited to provide participants with information that might be of potential importance to their evaluation of a given activity.

The following Activity Physician Director(s), planning committee member(s), speaker(s), author(s) or anyone in a position to control the content have reported the following financial interest or relationship* with various companies/organizations. The Activity Director and Planning Committee member roles were resolved by altering the individual’s control over content about the products or services of the commercial interest by the Associate Dean for CME and the Department of Medicine Chair. All potential conflict(s) were resolved.

* Kelly Kieffer, MD ~ her spouse is a consultant for OcculoBio. 

* Richard I. Rothstein, MD ~ has research support from Baranova (research grant to Dartmouth-Hitchcock Medical Center) and is on the Scientific Advisory Board for Allurion.

Other planning committee member(s), speaker(s), activity director(s), author(s) or anyone in a position to control the content for this program report no financial interest or relationship* with any company(ies) or organizations whose product may be germane to the content of their presentations.

*A “financial interest or relationship" refers to an equity position, receipt of royalties, consultantship, funding by a research grant, receiving honoraria for educational services elsewhere, or to any other relationship to a company that provides sufficient reason for disclosure, in keeping with the spirit of the stated policy.

Bibliographic References
  • See presentation for bibliographic sources to allow for further study.

Provider Contact Information

Provider contact information for questions regarding accreditation of the activity:

Center for Learning and Professional Development
Dartmouth-Hitchcock Medical Center

Type:     Internet Activity (Enduring Material)
2 Registered Users