Resistance to discontinuing breast cancer screening in older women: A qualitative study

Housten, Ashley J.; Pappadis, Monique R.; Krishnan, Shilpa; Weller, Susan C.; Giordano, Sharon H.; Bevers, Therese B.; Volk, Robert J.; Hoover, Diana S.

doi:10.1002/pon.4708

Cited by 13 publications

(39 citation statements)

References 41 publications

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“…Nine of the included studies were quantitative, 14 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 8 were qualitative, 13 , 29 , 30 , 31 , 32 , 33 , 34 , 35 and 4 used mixed methods. 36 , 37 , 38 , 39 Ten studies examined breast cancer screening, 21 , 22 , 24 , 25 , 29 , 30 , 31 , 32 , 36 , 39 3 assessed cervical cancer, 26 , 28 , 34 1 assessed prostate cancer, 23 and 7 assessed some combination of breast, prostate, cervical, and colorectal cancer screening. 13 , 14 , 27 , 33 , 35 , 37 , 38 Thirteen studies included women only, 21 , 22 , 24 , 25 , 26 , 28 , 29 , 30 , 31 , 32 , 34 , 36 , 39 1 included men only, 23 and 7 included a combination of men and women.…”

Section: Resultsmentioning

confidence: 99%

“…34 Five studies analyzed factors associated with screening intention 21 , 22 , 24 , 26 or willingness to stop, 28 1 assessed decisions within a discrete choice experiment for a hypothetical patient, 14 and 1 examined factors associated with the decision process (eg, goals, concerns, and knowledge). 27 Two studies asked closed questions about screening, 23 , 25 9 asked open questions about screening 29 , 31 , 32 , 34 , 39 or specifically about stopping, 13 , 30 , 33 , 35 and 3 asked both open and closed questions. 36 , 37 , 38 See Table 1 for a summary of the characteristics of the included studies.…”

Section: Resultsmentioning

confidence: 99%

“…Most studies included adults aged 65 years or older (17 of 21 studies), 13 , 14 , 21 , 22 , 25 , 26 , 28 , 29 , 30 , 31 , 32 , 34 , 35 , 36 , 37 , 38 , 39 3 included a subgroup of adults aged 65 years or older, 23 , 24 , 27 and 1 study reported a mean or median age 65 years or older and targeted recruitment via a senior health center. 33 Most had representation from younger (65-74 years) and older (≥75 years) age ranges, 13 , 14 , 21 , 22 , 23 , 25 , 26 , 28 , 29 , 30 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 except for 3 studies: 2 included only adults aged 75 years or older 27 or 80 years or older, 31 and 1 did not report an age range. 24 Many studies also included participants with self-reported fair to poor health, 13 , 23 , 28 , 30 , 31 , 39 2 or more health problems or comorbidities, 25 , 32 , 36 , 38 mild cognitive impairment, 33 life expectancy less than 10 years,…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2021

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IMPORTANCE Decisions for older adults (aged Ն65 years) and their clinicians about whether to continue to screen for cancer are not easy. Many older adults who are frail or have limited life expectancy or comorbidities continue to be screened for cancer despite guidelines suggesting they should not; furthermore, many older adults have limited knowledge of the potential harms of continuing to be screened. OBJECTIVETo summarize the patient-reported factors associated with older adults' decisions regarding screening for breast, prostate, colorectal, and cervical cancer.EVIDENCE REVIEW Studies were identified by searching databases from January 2000 to June 2020 and were independently assessed for inclusion by 2 authors. Data extraction and risk of bias assessment were independently conducted by 2 authors, and then all decisions were cross-checked and discussed where necessary. Data analysis was performed from September to December 2020. FINDINGSThe search yielded 2475 records, of which 21 unique studies were included. Nine studies were quantitative, 8 were qualitative, and 4 used mixed method designs. Of the 21 studies, 17 were conducted in the US, and 10 of 21 assessed breast cancer screening decisions only. Factors associated with decision-making were synthesized into 5 categories: demographic, health and clinical, psychological, physician, and social and system. Commonly identified factors associated with the decision to undergo screening included personal or family history of cancer, positive screening attitudes, routine or habit, to gain knowledge, friends, and a physician's recommendation. Factors associated with the decision to forgo screening included being older, negative screening attitudes, and desire not to know about cancer. Some factors had varying associations, including insurance coverage, living in a nursing home, prior screening experience, health problems, limited life expectancy, perceived cancer risk, risks of screening, family, and a physician's recommendation to stop. CONCLUSIONS AND RELEVANCEAlthough guidelines suggest incorporating life expectancy and health status to inform older adults' cancer screening decisions, older adults' ingrained beliefs about screening may run counter to these concepts. Communication strategies are needed that support older adults to make informed cancer screening decisions by addressing underlying screening beliefs in context with their perceived and actual risk of developing cancer.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

et al. 2021

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“…22,23 Patient attitudes and behaviors that contribute to that discomfort include anger and decreased trust with physicians who recommend screening cessation, and a desire for screening even if they would not undergo treatment for cancers identified. 20,24 These issues are reflected in our Theme 2 results, and highlight the need for a shared paradigm of screening between clinicians and patients. This may help ameliorate a key challenge to changing screening behavior: patients tend to overestimate the benefits and underestimate the potential harms of screening.…”

Section: Discussionmentioning

confidence: 92%

“…This is consistent with the limited literature that showed that older adults are reluctant to stop cancer screening based on life expectancy. 10 , 20 For example, the study by Housten et al 20 found that impaired health status and shorter life expectancy did not stop patients from wanting to continue breast cancer screening. Our study delves deeper in the reasons behind the low impact of life expectancy on the decision to continue or stop cancer screening.…”

Section: Discussionmentioning

confidence: 99%

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

Roy

Moss

Rodríguez-Colón

et al. 2020

J Prim Care Community Health

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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.

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Physician Adherence to Breast Cancer Screening Recommendations

Grady

Redberg

2017

JAMA Intern Med

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We found the Research Letter by Radhakrishnan et al 1 rather dispiriting. It suggests that a large proportion of primary care physicians recommend screening mammography for women who are more likely to experience harms than benefits from the examination. Owing to the greater chance of harm, neither the American Cancer Society nor the US Preventive Services Task Force (USPSTF) recommend routine screening mammography for women ages 40 to 44 years. Despite this, 81% of the primary care physicians surveyed in this study reported that they recommend mammography to women in this age range.In our view, the most evidence-based, transparent, and conflict-free guidelines are from the USPSTF. The USPSTF recommends routine biannual screening mammography for women between the ages of 50 and 74 years. 2 However, 88% of physicians in this study recommended routine mammography for women ages 45 to 50 years and 67% recommended mammography for women 75 and older. In addition, physicians inexplicably trusted other guidelines more than the USPSTF, which is publicly funded, uses strict methods, and carefully supports recommendations with evidence. Perhaps those who responded to this online survey of a random sample from the American Medical Association Physician Masterfile are not representative of US primary care physicians in general. But we doubt that these estimates could be biased enough

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Resistance to discontinuing breast cancer screening in older women: A qualitative study

Abstract: Among older women who planned to continue screening, intentions to continue breast cancer screening appear to be highly resilient and resistant to recommendations from physicians or expert/government panels.

Cited by 13 publications

References 41 publications

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

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

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

Physician Adherence to Breast Cancer Screening Recommendations

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