ideasIdea
Stop screening by life expectancy, not birthday, with a tool in the record
Screening someone unlikely to live ten years causes harm without benefit. A life-expectancy estimate in the medical record could stop invitations and prompt a conversation.
Many people with under ten years' life expectancy continue screening; conversely, healthy 76-year-olds are excluded. Propose an EHR-embedded life-expectancy tool (ePrognosis-type) that gates screening invitations, tested in an RCT with over-screening and under-screening as endpoints.
Hypothesis
Life-expectancy gating reduces screening in people with under ten years' expectancy by at least 30% and increases it in healthy older adults, with patient acceptance of at least 80%.
Rationale
Individualised cessation is guideline-endorsed but not implemented; deprescribing frameworks show it can be done.
What would test it
Run a cluster RCT in primary care.
Maturity
early clinical
Who has to act
clinic
Cost to try
Small (under $1M)
Years to first evidence
3
Bottlenecks it attacks
- Overdiagnosis and false alarms · Finding more cancer is not the same as saving lives. Screening also finds cancers that would never have hurt anyone, and treats them.
- Older and multimorbid patients are excluded and undertreated · Most people with cancer are over 65 but most trial patients are younger and fitter. We guess how to treat the majority.