Table 1. Summary of the five rules of thumb for making surveillance colonoscopy decisions in older adults.

Rules of thumb	Rationale	Example
1. Know the data	Knowing the data on CRC* risk and colonoscopy-related harms is essential if we are to make sound recommendations and have meaningful discussions with our patients.	Know the lifetime risk of CRC in patients with LRAs versus HRAs.
2. Get the full history	Incomplete information on prior colonoscopy quality and findings creates unnecessary ambiguity.	Obtain prior colonoscopy and pathology reports.
3. Individualize benefits and harms	Benefits and harms vary widely between patients, especially as they get older.	Use decision support tools (e.g., www.screeningdecision.com) and validated life expectancy calculators (e.g., ePrognosis).
4. Engage the patient	Understanding patients' perspectives can guide decision-making, especially in cases that are not clear cut.	Ask patients about their preferences and values, including worry about cancer and the burdens of colonoscopy.
5. Work with your colleagues	PCPs* know their patients' current medical and functional status and often have greater insight into their values and preferences.	Act as a consultant, providing clear guidance with appropriate qualifications that provide the PCP with flexibility.

CRC, colorectal cancer; HRA, high-risk adenoma; LRA, low-risk adenoma; PCP, primary care provider.