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

Abstract

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.

Patient-Reported Factors Associated With Older Adults’ Cancer Screening Decision-making

“…Roy et al, 35 2020 Attitudes and perceptions of cancer screening and overscreening Importance of tailored and targeted education and information: "But after you get informed, you really think about it. The best thing out there is the information."…”

“…27 In 3 studies, 14,37,38 many older adults agreed that they planned to get breast, prostate, and colorectal cancer screening for as long as they live. Similarly, negative screening attitudes consistently were associated with the decision to forgo screening across many studies, including simply not wanting screening, 26,36 lack of benefit or appropriateness, 33,37 disinterest, 37 test discomfort or pain, 26,29,[34][35][36] embarrassment or privacy concerns, 36 fatalism, 32,33,35 the potential trouble obtaining insurance coverage if the individual is identified as high risk, 26 and stress, time, or cost. 35 Routine and habit also were associated with the decision to undergo screening, 23,25,30,37 and forgetting was associated with forgoing screening.…”

“…Similarly, negative screening attitudes consistently were associated with the decision to forgo screening across many studies, including simply not wanting screening, 26,36 lack of benefit or appropriateness, 33,37 disinterest, 37 test discomfort or pain, 26,29,[34][35][36] embarrassment or privacy concerns, 36 fatalism, 32,33,35 the potential trouble obtaining insurance coverage if the individual is identified as high risk, 26 and stress, time, or cost. 35 Routine and habit also were associated with the decision to undergo screening, 23,25,30,37 and forgetting was associated with forgoing screening. 29,36 Perceived risk and fear of developing cancer were inconsistently operationalized and assessed across studies, meaning that findings were varied regarding their association with decision-making.…”

“…Qualitative findings suggested that screening risks may be associated with the decision to forgo screening 33,38 as well as knowledge of overdetection in 1 quantitative study. 39 However, 3 studies found low awareness of potential risks of screening, 35 low worry about risks of breast screening (low to moderate risk of bias), 36 and resistance to the concept of overdetection. 39 The association of screening knowledge or information with decision-making was extremely varied across included studies.…”

“…33 However, some older adults expressed a desire for specific, tailored information to justify a recommendation to stop screening. 35…”