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Original Investigation
June 12, 2017

Older Adults’ Views and Communication Preferences About Cancer Screening Cessation

Author Affiliations
  • 1The Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 2The Johns Hopkins University School of Public Health, Baltimore, Maryland
JAMA Intern Med. Published online June 12, 2017. doi:10.1001/jamainternmed.2017.1778
Key Points

Question  How do older adults think about stopping cancer screening when life expectancy is limited, and how do they prefer to discuss it with clinicians?

Findings  In this qualitative interview study with 40 community-dwelling older adults, participants were amenable to stopping cancer screening in the context of a trusting relationship with their clinician. Participants did not often consider life expectancy important in screening or prefer to hear about life expectancy when discussing screening.

Meaning  Better delineating patient-centered approaches to discuss screening cessation when life expectancy is limited is important for optimizing cancer screening in older adults.

Abstract

Importance  Older adults with limited life expectancy are frequently screened for cancer even though it exposes them to risks of screening with minimal benefit. Patient preferences may be an important contributor to continued screening.

Objective  To examine older adults’ views on the decision to stop cancer screening when life expectancy is limited and to identify older adults’ preferences for how clinicians should communicate recommendations to cease cancer screening.

Design, Setting, and Participants  In this semistructured interview study, we interviewed 40 community-dwelling older adults (≥ 65 years) recruited at 4 clinical programs affiliated with an urban academic medical center.

Main Outcomes and Measure  We transcribed the audio recorded discussions and analyzed the transcripts using standard techniques of qualitative content analysis to identify major themes and subthemes.

Results  The participants’ average age was 75.7 years. Twenty-three participants (57.5%) were female; 25 (62.5%) were white. Estimated life expectancy was less than 10 years for 19 participants (47.5%). We identified 3 key themes. First, participants were amenable to stopping cancer screening, especially in the context of a trusting relationship with their clinician. Second, although many participants supported using age and health status to individualize the screening decision, they did not often understand the role of life expectancy. All except 2 participants objected to a Choosing Wisely statement about not recommending cancer screening in those with limited life expectancy, often believing that clinicians cannot accurately predict life expectancy. Third, participants preferred that clinicians explain a recommendation to stop screening by incorporating individual health status but were divided on whether life expectancy should be mentioned. Specific wording of life expectancy was important; many felt the language of “you may not live long enough to benefit from this test” was unnecessarily harsh compared with the more positive messaging of “this test would not help you live longer.”

Conclusions and Relevance  Although research and clinical practice guidelines recommend using life expectancy to inform cancer screening, older adults may not consider life expectancy important in screening and may not prefer to hear about life expectancy when discussing screening. The described communication preferences can help inform future screening discussions. Better delineating patient-centered approaches to discuss screening cessation is an important step toward optimizing cancer screening in older adults.

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