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Original Investigation
April 8, 2013

Older Adults and Forgoing Cancer Screening: “I Think It Would Be Strange”

Author Affiliations

Author Affiliations: Indiana University Center for Aging Research (Drs Torke and Sachs and Mss Holtz and Montz); Regenstrief Institute (Drs Torke and Sachs and Mss Holtz and Montz); Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine (Drs Torke, Schwartz, and Sachs); Charles Warren Fairbanks Center for Medical Ethics, Indiana University Health (Dr Torke); and Indiana University Center for Bioethics (Dr Schwartz), Indianapolis.

JAMA Intern Med. 2013;173(7):526-531. doi:10.1001/jamainternmed.2013.2903

Importance Although there is a growing recognition that older adults and those with extensive comorbid conditions undergo cancer screening too frequently, there is little information about patients' perceptions regarding cessation of cancer screening. Information on older adults' views of screening cessation would be helpful both for clinicians and for those designing interventions to reduce overscreening.

Objective To obtain a deeper understanding of older adults' perspectives on screening cessation and their experiences communicating with clinicians about this topic.

Design Semistructured interview study.

Setting Senior health center affiliated with an urban hospital.

Participants We interviewed 33 older adults presenting to a senior health center. Their median age was 76 years (range, 63-91 years). Of the 33 participants, 27 were women; 15 were African American, 16 were white, 1 was Asian, and 1 was American Indian.

Main Outcome Measures We transcribed audio recordings of interviews and analyzed them using methods of grounded theory to identify themes and illustrative quotes.

Results Undergoing screening tests was perceived by participants as morally obligatory. Although many saw continued screening as a habit or custom not involving any decision, cessation of screening would require a major decision. Many asserted that they had never discussed screening cessation with their physicians or considered stopping on their own; some reported being upset when their physician recommended stopping. Although some would accept a physician's strong recommendation to stop, others thought that such a physician's recommendation would threaten trust or lead them to get another opinion. Participants were skeptical about the role of statistics and the recommendations of government panels in screening decisions but were more favorable toward stopping because of the balance of risks and benefits, complications, or test burdens.

Conclusions and Relevance For many older adults, stopping screening is a major decision, but continuing screening is not. A physician's recommendation to stop may threaten patient trust. Effective strategies to reduce nonbeneficial screening may include discussion of the balance of risks and benefits, complications, or burdens.