Demographic, health, and attitudinal factors predictive of cancer screening decisions in older adults

Abstract

Many older adults receive routine cancer screening even when it is no longer recommended. We sought to identify demographic, health-related, and attitudinal factors that are most predictive of continued breast, colorectal, and prostate cancer screening decisions in older adults under various scenarios. A sample of adults age 65+ (n = 1272) were recruited from a nationally representative panel in November 2016, of which 881 (69.3%) completed our survey. Participants were presented vignettes in which we experimentally varied a hypothetical patient's life expectancy, age, quality of life, and physician screening recommendation. The dependent variable was the choice to continue cancer screening in the vignette. Classification and regression tree (CART) analysis was used to identify characteristics most predictive of screening decisions; both the participants' characteristics and the hypothetical patient's characteristics in the vignettes were included in the analysis. CART analysis uses recursive partitioning to create a classification tree in which variables predictive of the outcome are included as hierarchical tree nodes. We used automated ten-fold cross-validation to select the tree with lowest misclassification and highest predictive accuracy. Participants' attitude towards cancer screening was most predictive of choosing screening. Among those who agreed with the statement “I plan to get screened for cancer for as long as I live” (n = 300, 31.9%), 73.2% chose screening and 57.2% would still choose screening if hypothetical patient had 1-year life expectancy. For this subset of older adults with enthusiasm towards screening even when presented with scenario involving limited life expectancy, efforts are needed to improve informed decision-making about screening.

Effect of different communication strategies about stopping cancer screening on screening intention and cancer anxiety: a randomised online trial of older adults in Australia

“…20 21 Some older adults' attitudes toward screening are now a more important predictor of their screening decision than a clinician's recommendation. 22 Additionally, health professionals hesitate to inform patients about confusing potential harms such as overdiagnosis 23 and the majority (around 75%) of older American adults recall no conversation with a doctor that screening for breast or prostate cancer may no longer be necessary. 19 These conversations inherently involve sensitive and uncertain topics that clinicians feel uncomfortable to raise with their older patients.…”

Enhanced Directed Random Walk for the Identification of Breast Cancer Prognostic Markers from Multiclass Expression Data

“…Among the use of classifiers, a logistic regression model was used by eDRW+, for a better classification performance. The logistic regression model was a non-parametric and multivariate statistical method for classification [ 46 ]. Because there was no assumption for the distribution of the predictor variables, the logistic regression model was relatively robust, and was easily used as a classifier for a meaningful interpretation.…”

“…Figure 5 presents the difference between DRW (a) and eDRW+ (b), without and with the selection of the pathways. Because the pathways were typically collected from a curated community database, the presence of non-informative data can lead to low classification accuracy and increase the risk of over-fitting [ 30 , 43 , 44 , 45 , 46 ]. Therefore, the selection of the top 100 ranking pathways in pathway activities has been proposed, based on the greatest reproducibility power.…”

Temporal trends and regional disparities in cancer screening utilization: an observational Swiss claims-based study

“…However, while many guidelines consistently recommend the use of some preventive measures, such as colorectal cancer screening in certain age groups [ 6 ], other screenings, such as breast cancer screening, continue to be controversial because it is unclear whether lifetime benefits outweigh harms and costs in individuals [ 7 ]. Many adults receive routine cancer screening even in old age when it is no longer recommended [ 8 ]. The burden associated with overdiagnosis and overtreatment is becoming an increasingly recognized issue.…”

“…Besides system-related factors, like the existence of national or cantonal screening programs, further factors seem to play a role in whether or not persons participate in cancer screening, such as individual and supply-related variables [ 8 , 19 – 22 ]. Furthermore, the patient’s type of health insurance plan and healthcare utilization (such as physician consultations) were associated with cancer screening utilization [ 23 , 24 ].…”