Preferred Clinician Communication About Stopping Cancer Screening Among Older US Adults

Schoenborn, Nancy L.; Janssen, Ellen; Boyd, Cynthia M.; Bridges, John F.P.; Wolff, Antonio C.; Pollack, Craig Evan

doi:10.1001/jamaoncol.2018.2100

Cited by 29 publications

(29 citation statements)

References 7 publications

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“…A recent study of adults aged 65 years and older reported that, although older adults were amenable to using age and health status within the context of discussing screening cessation, there were concerns with discussions overly focused on life expectancy . Another study found that patients prefer clinicians to frame the decision to stop screening in terms of prioritizing other health issues . As in all interactions between providers and patients, an informed, shared decision with clear communication of the risks and benefits of cancer screening or treatment should be the centerpiece of clinical care.…”

Section: Selected Findingsmentioning

confidence: 99%

“…61 Another study found that patients prefer clinicians to frame the decision to stop screening in terms of prioritizing other health issues. 62 As in all interactions between providers and patients, an informed, shared decision with clear communication of the risks and benefits of cancer screening or treatment should be the centerpiece of clinical care. Although most guidelines generally recommend against cancer screening in those with less than a 10-year life expectancy, differences across organizations can complicate decisions for patients and their providers.…”

Section: Cancer Screeningmentioning

confidence: 99%

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Cancer statistics for adults aged 85 years and older, 2019

DeSantis

Miller

Dale

et al. 2019

CA A Cancer J Clinicians

297

199

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Adults aged 85 years and older, the “oldest old,” are the fastest‐growing age group in the United States, yet relatively little is known about their cancer burden. Combining data from the National Cancer Institute, the North American Association of Central Cancer Registries, and the National Center for Health Statistics, the authors provide comprehensive information on cancer occurrence in adults aged 85 years and older. In 2019, there will be approximately 140,690 cancer cases diagnosed and 103,250 cancer deaths among the oldest old in the United States. The most common cancers in these individuals (lung, breast, prostate, and colorectum) are the same as those in the general population. Overall cancer incidence rates peaked in the oldest men and women around 1990 and have subsequently declined, with the pace accelerating during the past decade. These trends largely reflect declines in cancers of the prostate and colorectum and, more recently, cancers of the lung among men and the breast among women. We note differences in trends for some cancers in the oldest age group (eg, lung cancer and melanoma) compared with adults aged 65 to 84 years, which reflect elevated risks in the oldest generations. In addition, cancers in the oldest old are often more advanced at diagnosis. For example, breast and colorectal cancers diagnosed in patients aged 85 years and older are about 10% less likely to be diagnosed at a local stage compared with those diagnosed in patients aged 65 to 84 years. Patients with cancer who are aged 85 years and older have the lowest relative survival of any age group, with the largest disparities noted when cancer is diagnosed at advanced stages. They are also less likely to receive surgical treatment for their cancers; only 65% of breast cancer patients aged 85 years and older received surgery compared with 89% of those aged 65 to 84 years. This difference may reflect the complexities of treating older patients, including the presence of multiple comorbidities, functional declines, and cognitive impairment, as well as competing mortality risks and undertreatment. More research on cancer in the oldest Americans is needed to improve outcomes and anticipate the complex health care needs of this rapidly growing population.

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Section: Selected Findingsmentioning

confidence: 99%

Section: Cancer Screeningmentioning

confidence: 99%

Cancer statistics for adults aged 85 years and older, 2019

DeSantis

Miller

Dale

et al. 2019

CA A Cancer J Clinicians

297

199

View full text Add to dashboard Cite

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“…[12][13][14] Because best practices for discussing cancer screening cessation are largely undefined, we explored, in our prior work, older adults' preferred communication strategies for clinicians to discuss stopping cancer screening. 15 We found that older adults most preferred their clinicians to describe stopping cancer screening in relation to "focusing on other health priorities" while discussing discomfort or inconvenience of the screening test, life expectancy, or not bring up a discussion were viewed more negatively. 15 The main limitation of this prior work was that it relied on an existing online survey panel.…”

Section: Introductionmentioning

confidence: 87%

“…15 We found that older adults most preferred their clinicians to describe stopping cancer screening in relation to "focusing on other health priorities" while discussing discomfort or inconvenience of the screening test, life expectancy, or not bring up a discussion were viewed more negatively. 15 The main limitation of this prior work was that it relied on an existing online survey panel. Although the panel is nationally representative in demographic composition, the panelists tend to have high health literacy which may be an important determinant of the way patients would like to receive information about stopping cancer screening.…”

Section: Introductionmentioning

confidence: 87%

“…Details about the national survey have been previously described. 15 Older adults 65 years and older and English-speaking were recruited from KnowledgePanel, a probability-based online panel designed to be representative of US adults living in households. 21 Panel members are recruited by random digit dialing and address-based sampling.…”

Section: Study Design and Samplementioning

confidence: 99%

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Examining Generalizability of Older Adults’ Preferences for Discussing Cessation of Screening Colonoscopies in Older Adults with Low Health Literacy

et al. 2019

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BACKGROUND/OBJECTIVES: Many older adults receive unnecessary screening colonoscopies. We previously conducted a survey using a national online panel to assess older adults' preferences for how clinicians can discuss stopping screening colonoscopies. We sought to assess the generalizability of those results by comparing them to a sample of older adults with low health literacy. DESIGN: Cross-sectional survey. SETTING: Baltimore metropolitan area (low health literacy sample) and a national, probability-based online panel-KnowledgePanel (national sample). PARTICIPANTS: Adults 65+ with low health literacy measured using a single-question screen (low health literacy sample, n = 113) and KnowledgePanel members 65+ who completed survey about colorectal cancer screening (national sample, n = 441). MEASUREMENTS: The same survey was administered to both groups. Using the best-worst scaling method, we assessed relative preferences for 13 different ways to explain stopping screening colonoscopies. We used conditional logistic regression to quantify the relative preference for each explanation, where a higher preference weight indicates stronger preference. We analyzed each sample separately, then compared the two samples using Spearman's correlation coefficient, the likelihood ratio test to assess for overall differences between the two sets of preference weights, and the Wald test to assess differences in preference weights for each individual phrases. RESULTS: The responses from the two samples were highly correlated (Spearman's coefficient 0.92, p < 0.0001). The most preferred phrase to explain stopping screening colonoscopy was "Your other health issues should take priority" in both groups. The three least preferred options were also the same for both groups, with the least preferred being "The doctor does not give an explanation." The explanation that referred to "quality of life" was more preferred by the low health literacy group whereas explanations that mentioned "unlikely to benefit" and "high risk for harms" were more preferred by the national survey group (all p < 0.001). CONCLUSION: Among two different populations of older adults with different health literacy levels, the preferred strategies for clinicians to discuss stopping screening colonoscopies were highly correlated. Our results can inform effective communication about stopping screening colonoscopies in older adults across different health literacy levels.

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