Abstract
Background and Objectives
Adults >75 years are overscreened for cancer, especially those with <10-year life expectancy. This study aimed to learn the effects of providing primary care providers (PCPs) with scripts for discussing stopping mammography and colorectal cancer (CRC) screening and with information on patient 10-year life expectancy on their patients’ intentions to be screened for these cancers.
Research Design and Methods
Patient participants, identified via PCP appointment logs, completed a questionnaire pre and post-visit. PCPs were given scripts for discussing stopping screening and information on patient 10-year life expectancy before these visits. PCPs completed a questionnaire at the end of the study. Patients and PCPs were asked about discussing stopping cancer screening and patient life expectancy. Patient screening intentions (1-15 Likert-scale; lower scores suggest lower intentions) were compared pre and post-visit using the Wilcoxon signed rank test.
Results
90 patients >75 years (47% of eligible patients reached by phone) from 45 PCPs participated. Patient mean age was 80.0 years SD=2.9), 43 (48%) were female, and mean life expectancy was 9.7 years (SD=2.4). Thirty-seven PCPs (12 community-based) completed a questionnaire. PCPs found the scripts helpful (32, [89%]) and thought they would use them frequently (29, [81%]). PCPs also found patient life expectancy information helpful (35 [97%]). However, only 8 PCPs (22%) reported feeling comfortable discussing patient life expectancy. Patients’ intentions to undergo CRC screening (9.0 [SD=5.3] to 6.5 [SD=6.0], p<0.0001) and mammography screening (12.9 [SD=3.0] to 11.7 [SD=4.9], p=0.08) decreased from pre to post-visit (significantly for CRC). Sixty-three percent of patients (54/86) were interested in discussing life expectancy with their PCP pre-visit and 56% (47/84) post-visit.
Discussion and Implications
PCPs found scripts for discussing stopping cancer screening and information on patient life expectancy helpful. Possibly as a result, their patients over age 75 had lower intentions of being screened for CRC.
Trial Registration
ClinicalTrials.gov Identifier: NCT03480282