The study is among the first to explore older adults’ perceptions of recommendations to halt screenings for breast, prostate, colon and other cancers as they age.
“Older Adults and Forgoing Cancer Screening: ‘I think it would be strange’” was published Online First by JAMA Internal Medicine. “I think it would be strange” was an older adult’s reaction when asked about a physician advising against a screening.
The researchers — led by Regenstrief Institute investigator Alexia Torke, M.D., an IU Center for Aging Research scientist and an assistant professor of medicine at the IU School of Medicine — report that many older adults feel a strong moral obligation to continue cancer screenings and that a physician’s recommendation to stop screening might threaten trust in the doctor or motivate the patient to seek a second opinion.
“In this era of attention to over-testing, there is a growing recognition in the medical community that some older adults are screened for cancer when it is not beneficial or even potentially harmful to that person,” Dr. Torke said. “If physicians are going to successfully communicate with their older patients about forgoing screening they, as well as other care providers, need to understand how older adults view these screenings.”
In open-ended interviews with older adults with a mean age of 76, the researchers found patients viewed screening as an automatic, recommended or obligatory action. According to Dr. Torke, this confirms the success of public health campaigns in communicating the health benefits of screening. The study findings, she says, highlight the need to develop specific messages for older adults that don’t undermine the messages targeted to other groups.
However, study participants seemed to respond well to the idea that screening does not make sense if the burdens — such as pain, time requirements or stress — can be expected to outweigh the benefits. For example, the burdens of colonoscopy were repeatedly cited as reasons not to continue with this test as the patient aged.
Participants were skeptical about hearing government panel recommendations and statistics that show that older adults may not benefit from certain screening tests. Many expressed distrust of the government or felt statistics did not apply to them.
Study participants ranged in age from 63 to 90.
“Each patient is different, but when speaking with older adults or the caregivers of those who can no longer make decisions for themselves about reducing screenings, the discussion needs to clearly outline the balance of risks and benefits for the specific individual. This approach has the greatest chance of building trust and understanding,” Dr. Torke said.
In addition to Dr. Torke, who is also a faculty member of the Fairbanks Center for Medical Ethics of IU Health, co-authors of the study are Peter H. Schwartz, M.D., Ph.D., of the IU School of Medicine and IU Center for Bioethics; Laura R. Holtz, B.S., and Kianna Montz, M.A., of the Regenstrief Institute and the IU Center for Aging Research; and Greg A. Sachs, M.D., of the Regenstrief Institute, IU School of Medicine and IU Center for Aging Research.
The study was funded by a grant (P30AG024967) from the National Institute on Aging.
JAMA Intern Med. Published online March 11, 2013. doi:10.1001/jamainternmed.2013.2903.
Cindy Fox Aisen