Abstract
BackgroundIndividualized decision making has been recommended for cancer screening decisions in older adults. Because older adults' preferences are central to individualized decisions, we assessed older adults' perspectives about continuing cancer screening later in life.MethodsFace to face interviews with 116 residents age 70 or over from two long-term care retirement communities. Interview content included questions about whether participants had discussed cancer screening with their physicians since turning age 70, their attitudes about information important for individualized decisions, and their attitudes about continuing cancer screening later in life.ResultsForty-nine percent of participants reported that they had an opportunity to discuss cancer screening with their physician since turning age 70; 89% would have preferred to have had these discussions. Sixty-two percent believed their own life expectancy was not important for decision making, and 48% preferred not to discuss life expectancy. Attitudes about continuing cancer screening were favorable. Most participants reported that they would continue screening throughout their lives and 43% would consider getting screened even if their doctors recommended against it. Only 13% thought that they would not live long enough to benefit from cancer screening tests. Factors important to consider stopping include: age, deteriorating or poor health, concerns about the effectiveness of the tests, and doctors recommendations.ConclusionThis select group of older adults held positive attitudes about continuing cancer screening later in life, and many may have had unrealistic expectations. Individualized decision making could help clarify how life expectancy affects the potential survival benefits of cancer screening. Future research is needed to determine whether educating older adults about the importance of longevity in screening decisions would be acceptable, affect older adults' attitudes about screening, or change their screening behavior.
Highlights
Individualized decision making has been recommended for cancer screening decisions in older adults
To accommodate the wide variation in life expectancy, individualized decision making is recommended for cancer screening decisions later in life [3,8,9]
A nurse led program to promote individualized decision making in a continuing care retirement community demonstrated a decrease in screening behaviors over one year; these results were not statistically significant the number of participants was small [12]. These results suggest that education could promote individualized decision making, but it did not examine attitudes toward the information thought necessary for an informed decision or its relevance to decision making
Summary
Individualized decision making has been recommended for cancer screening decisions in older adults. Cancer is an important cause of morbidity and mortality in older adults [1], the incidence of other serious conditions increases with age These competing causes of mortality decrease the likelihood that an older individual could experience a survival benefit from cancer screening [2] because cancers are relatively slow growing. To accommodate the wide variation in life expectancy, individualized decision making is recommended for cancer screening decisions later in life [3,8,9] During this process, older adults and their physicians consider the risk of dying from cancer, dying from other causes besides cancer, the risks and benefits of screening, and personal preferences [3]
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