Discussion Strategies That Primary Care Clinicians Use When Stopping Cancer Screening in Older Adults

Schoenborn, Nancy L.; Bowman, Theron L.; Cayea, Danelle; Boyd, Cynthia M.; Feeser, Scott; Pollack, Craig Evan

doi:10.1111/jgs.14444

Cited by 13 publications

(21 citation statements)

References 10 publications

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“…28 Currently, clinicians use a variety of approaches to discuss cessation of screening without clear best practices. 41 Our results add to the literature by showing that many participants preferred explanations that included individualized health status but disliked explanations that mentioned life expectancy with a negative framing (“you may not live long enough to benefit from this test”).…”

Section: Discussionsupporting

confidence: 63%

Older Adults’ Views and Communication Preferences About Cancer Screening Cessation

et al. 2017

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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 PARTICIPANTSIn this semistructured interview study, we interviewed 40 community-dwelling older adults (Ն 65 years) recruited at 4 clinical programs affiliated with an urban academic medical center. MAIN OUTCOMES AND MEASUREWe transcribed the audio recorded discussions and analyzed the transcripts using standard techniques of qualitative content analysis to identify major themes and subthemes. RESULTSThe 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 RELEVANCEAlthough 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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Section: Discussionsupporting

confidence: 63%

Older Adults’ Views and Communication Preferences About Cancer Screening Cessation

et al. 2017

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“…Consider whether the patient has advanced illness or limited life expectancy that affects benefits and harms of treatments Consider health trajectory and time to benefit for preventive interventions Explain cessation of screening and prevention as a shift in priorities and use positive messaging …”

Section: Actions and Action Steps For Care Of Older Adults With Mccsmentioning

confidence: 99%

Decision Making for Older Adults With Multiple Chronic Conditions: Executive Summary for the American Geriatrics Society Guiding Principles on the Care of Older Adults With Multimorbidity

Boyd

Smith

Masoudi

et al. 2019

J American Geriatrics Society

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Caring for older adults with multiple chronic conditions (MCCs) is challenging. The American Geriatrics Society (AGS) previously developed The AGS Guiding Principles for the Care of Older Adults With Multimorbidity using a systematic review of the literature and consensus. The objective of the current work was to translate these principles into a framework of Actions and accompanying Action Steps for decision making for clinicians who provide both primary and specialty care to older people with MCCs. A work group of geriatricians, cardiologists, and generalists: (1) articulated the core MCC Actions and the Action Steps needed to carry out the Actions; (2) provided decisional tips and communication scripts for implementing the Actions and Action Steps, using commonly encountered situations: (3) performed a scoping review to identify evidence‐based, validated tools for carrying out the MCC Actions and Action Steps; and (4) identified potential barriers to, and mitigating factors for, implementing the MCC Actions. The recommended MCC Actions include: (1) identify and communicate patients' health priorities and health trajectory; (2) stop, start, or continue care based on health priorities, potential benefit vs harm and burden, and health trajectory; and (3) align decisions and care among patients, caregivers, and other clinicians with patients' health priorities and health trajectory. The tips and scripts for carrying out these Actions are included in the full MCC Action Framework available in the supplement (http://www.geriatricscareonline.org). J Am Geriatr Soc 67:665–673, 2019.

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“…There are no clear guidelines for clinicians to follow in approaching end-of-screening conversations with patients. 21 Physicians are uncomfortable with end-of-life discussions. 22 , 23 Patient attitudes and behaviors that contribute to that discomfort include anger and decreased trust with physicians who recommend screening cessation, and a desire for screening even if they would not undergo treatment for cancers identified.…”

Section: Discussionmentioning

confidence: 99%

Examining Older Adults’ Attitudes and Perceptions of Cancer Screening and Overscreening: A Qualitative Study

Roy

Moss

Rodríguez-Colón

et al. 2020

J Prim Care Community Health

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Introduction/Objectives: Screening guidelines for breast, cervical, and colorectal cancer (CRC) are less clear for older adults due to the potential harms that may result from screening. Understanding older adults’ attitudes and perceptions, especially racial/ethnic minority and underserved adults, of cancer screening can help health care providers determine how best to communicate with older adults about cancer screening and screening cessation. The objective of this study was to determine how older adults primarily from minority/underserved backgrounds perceive cancer screening and overscreening. Methods: Four focus groups (n = 39) were conducted with adults (>=65 years of age) in 3 community settings in south-central Pennsylvania. Two focus groups were conducted in Spanish and translated to English upon transcription. Focus group data was managed and analyzed using QSR NVivo 12. Inductive thematic analysis was used to analyze the data where themes emerged following the coding process. Results: The focus group participants had an average age of 74 years and were primarily female (74%) and Hispanic (69%), with 69% reporting having less than a high school degree. Four key themes were identified from the focus groups: (1) importance of tailored and targeted education/information; (2) impact of physician/patient communication; (3) impact of barriers and facilitators to screening on cancer screening cessation; and (4) awareness of importance of screening. Participants were more likely to be agreeable to screening cessation if they received specific information regarding their health status and previous medical history from their physician as to why screening should be stopped and told by their physician that the screening decision is up to them. Conclusions: Older adults prefer individualized information from their physician in order to justify screening cessation but are against incorporating life expectancy into the discussion. Future research should focus on developing interventions to test the effectiveness of culturally tailored screening cessation messages for older adults.

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Discussion Strategies That Primary Care Clinicians Use When Stopping Cancer Screening in Older Adults

Cited by 13 publications

References 10 publications

Older Adults’ Views and Communication Preferences About Cancer Screening Cessation

Older Adults’ Views and Communication Preferences About Cancer Screening Cessation

Decision Making for Older Adults With Multiple Chronic Conditions: Executive Summary for the American Geriatrics Society Guiding Principles on the Care of Older Adults With Multimorbidity

Examining Older Adults’ Attitudes and Perceptions of Cancer Screening and Overscreening: A Qualitative Study

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