Decisions about medication use and cancer screening across age groups in the United States

Fairfield, Kathleen M.; Gerstein, Bethany S.; Levin, Carrie A.; Stringfellow, Vickie L.; Wierman, Heidi R.; McNaughton-Collins, Mary

doi:10.1016/j.pec.2014.11.012

Cited by 12 publications

(25 citation statements)

References 38 publications

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“…Across a range of treatment and screening decisions, patients are often not optimally included. 22,23,26,31 Similar to other medical decisions, respondents reported that clinicians discussed the pros of antidepressant treatment more than the cons. 27 In this analysis, for those with less formal education, the cons of the decision were discussed less often compared with those with more education.…”

Section: Discussionmentioning

confidence: 79%

National Survey of Decision-Making for Antidepressants and Educational Level

et al. 2020

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Background: Despite recommendations to screen adults for depression in primary care, little is known about how people across education levels decide to treat their depression and factors that influence their decision. Methods: We conducted a secondary analysis of a national, probability-based web survey in Englishspeaking adults aged 40 or older living in the United States who reported they discussed starting or continuing an antidepressant with their clinician in the past 2 years. Respondents answered questions about knowledge, decision-making process, and demographics. Education level was analyzed using 5 ordered categories. The Shared Decision Making (SDM) Process score was used to assess patient involvement. Descriptive statistics, 2 tests, analysis of variance, and regression models were used to describe the data and test associations. Results: Of the 5682 people invited, 3396 answered questions about health decisions (59.8% response rate) and 385 reported discussing antidepressants. The mean percentage of knowledge questions answered correctly increased as education level increased (P ‫؍‬ .008). The mean SDM Process score also increased with education (P ‫؍‬ .001). There was an association between education and who made the treatment decision, suggesting that for respondents with less education, the clinician was more likely to decide (P ‫؍‬ .001). Respondents with less education were less likely to report they would definitely make the same decision again (P ‫؍‬ .000). Conclusions: Those with less education were even less informed, had lower SDM Process scores and were less likely to think they made the right decision about antidepressants. There is a need to ensure patients are better informed about and involved in treatment for depression. (J Am Board Fam Med 2020;33:80-90.

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Section: Discussionmentioning

confidence: 79%

National Survey of Decision-Making for Antidepressants and Educational Level

et al. 2020

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“…Therefore, to prevent older women with a life expectancy of less than 10 years from being screened, PCPs must talk to older women about the need to stop being screened, but these conversations are notoriously difficult because they require consideration and often discussion of life expectancy. Possibly as a result, few (<5%) older adults report that they have discussed stopping screening with their physicians …”

Section: Recommendations For Discussing Stopping Mammography Screeningmentioning

confidence: 99%

“…Possibly as a result, few (<5%) older adults report that they have discussed stopping screening with their physicians. 9,10,43 As a guide for discussing stopping mammography screening with older women, I recommend (that clinicians initiate and re-initiate discussions about stopping screening years before they plan to recommend stopping to prepare older women, estimate life expectancy to individualize the benefits and risks of screening, inform older women of the benefits and risks and clarify their values about the potential outcomes, encourage women to use health promotion measures more likely to help them during their life-span (e.g., exercise), and reassure older women that they would still evaluate troubling breast symptoms with a mammogram. 22 Describing how the harms of cancer screening increase with rising age and worsening health, whereas the benefits of screening are uncertain has been found to be an acceptable approach to discussing stopping screening with older adults.…”

Section: Recommendations For Discussing Stopping Mammography Screeningmentioning

confidence: 99%

Decision‐Making Regarding Mammography Screening for Older Women

Schonberg

2016

J American Geriatrics Society

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The population is aging and breast cancer incidence increases with age peaking between ages 75–79. However, it is not known if mammography screening helps women ≥75 years live longer since none of these women were included in randomized controlled trials evaluating mammography screening. Guidelines recommend that older women with <10-year life expectancy not be screened since it takes approximately 10 years before a screen-detected breast cancer may impact an older woman’s survival. For women ≥75 years with ≥10 year life expectancy, guidelines recommend that clinicians discuss the benefits and risks of screening with older women to help these women elicit their values and preferences. It is estimated that 2 out of 1,000 women that continue to be screened biennially from ages 70–79 may avoid breast cancer death. However, 12–27% of these women will experience a false positive test and 10–20% of women that experience a false positive test undergo a benign breast biopsy. In addition, approximately 30% of screen-detected cancers would not otherwise have shown up in an older woman’s lifetime. Yet nearly all older women undergo treatment for these breast cancers and the risks of treatment increase with age. To inform decision-making, tools are available to estimate patient life expectancy and to educate older women about the benefits and harms of mammography screening. In addition, guides are available to help clinicians discuss stopping screening with older women with <10 year life expectancy. Ideally, screening decisions would consider an older woman’s life expectancy, breast cancer risk, and her values and preferences.

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“…Studies of shared decision‐making in breast, colorectal and prostate cancer screening revealed that patient/provider communications are often ineffective . Elston Lafata et al .…”

Section: Introductionmentioning

confidence: 99%

“…In some cases, patients made decisions with the aid of their provider (27%‐38%); only a few patients relied on health‐care providers’ opinion alone. Yet, these studies showed that health‐care providers usually failed to encourage a balanced discussion of screening and patients’ preferences . This failing might have reduced the quality of the cancer screening decision and may have precluded patients from making an autonomous decision.…”

Section: Introductionmentioning

confidence: 99%

Decision making about Pap test use among Korean immigrant women: A qualitative study

Kim

Gallo

et al. 2016

Health Expectations

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BackgroundUnderstanding how individuals make decisions about Pap tests concerning their personal values helps health‐care providers offer tailored approaches to guide patients’ decision making. Yet research has largely ignored decision making about Pap tests among immigrant women who experience increased risk of cervical cancer.ObjectiveTo explore decision making about Pap tests among Korean immigrant women.MethodsWe conducted a qualitative descriptive study using 32 semi‐structured, in‐depth interviews with Korean immigrant women residing in a north‐eastern metropolitan area. Data were audio‐recorded, transcribed verbatim and analysed using inductive coding.ResultsAlthough most women with positive decisions made their own decisions, some women deferred to their providers, and others made decisions in collaboration with their providers and significant others. While women making positive decisions tended to consider both barriers to and facilitators of having Pap tests, women making negative decisions predominantly discussed the barriers to having Pap tests, such as modesty and differences between the South Korean and US health‐care systems. The women's reflections on their decisions differed regarding their Pap test decisions.ConclusionsWomen's desired roles in the decision‐making process and reflection on their decision outcome appeared to vary, although most participants with positive decisions made their own decisions and were satisfied with their decisions. Future research should conduct longitudinal, quantitative studies to test our findings regarding decision‐making processes and outcomes about Pap tests.ImplicationsThe findings should be incorporated into cervical cancer screening practices to fulfil the unmet needs of immigrant women in patient‐provider communication and to facilitate women's decision making about Pap tests.

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Decisions about medication use and cancer screening across age groups in the United States

Cited by 12 publications

References 38 publications

National Survey of Decision-Making for Antidepressants and Educational Level

National Survey of Decision-Making for Antidepressants and Educational Level

Decision‐Making Regarding Mammography Screening for Older Women

Decision making about Pap test use among Korean immigrant women: A qualitative study

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