July 27, 2017

How Do Older Adults Feel About Forgoing Cancer Screenings?

Study looks at doctor-patient communication on screenings

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Cancer screenings are part of standard medical care, however, recent studies are showing that patients of advanced age or illness often do not benefit from this testing. A team at The Johns Hopkins University School of Medicine recently conducted a study to get a deeper understanding of older adults’ perspectives on screening cessation and communication with clinicians on this topic. Ronan Factora, MD, answers a few questions about study results.

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Is this research important?

Discussions about cancer screening occur very frequently in the clinical setting, and knowledge of the kind of language that is most effective can help physicians refine their technique.

What is the key take home message from this study?

There were several take home messages. Patients state that their trust in the physician is the biggest influence on whether or not they agree with the physician’s recommendations to screen or not screen. We also learned that the use of the term “life expectancy” had limited usefulness to the patient. Health status seemed to be a more important factor for patients when making a decision to forgo further cancer screening. Patients preferred to hear statements like “this test is not going to help you live longer” or “this test is not going to be helpful,” rather than statements like “you are not going to live 10 years.”

Should the findings change patient management?

Yes. The perception of the patient in using terms such as “life expectancy” and “health status” should prompt physicians to avoid using terms that are misunderstood or ambiguous. Framing cancer screening discussions in the context of whether or not the screening will allow a patient to live longer appears to be more successful.

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What are the study’s strongest points?

The study sampled individuals from a broad range of locations (ambulatory settings, home, primary care, internal medicine and geriatric medicine), and it is likely that patients seen at these locations would have similar perspectives. Individuals interviewed were 75 and older and were diverse so it was representative of the general population.

What are the main limitations of the study?

There were limited numbers of individuals involved, many of whom had a trusting relationship with their physicians. It is unclear if there would be similar results in a discussion with physicians that the patients did not know so well. The study also relied on self-reporting for the data, so responses to questions may not reflect how individuals would act in real life.

Though individuals with cognitive impairment were included in this study, many individuals with significant enough cognitive impairment require a surrogate decision maker to help them. It is unclear how surrogate decision makers would react to this discussion.

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Go to PubMed Journals for more details and a link to JAMA for the full article.

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