TY - JOUR
T1 - Discontinuing Cancer Screening for Older Adults
T2 - a Comparison of Clinician Decision-Making for Breast, Colorectal, and Prostate Cancer Screenings
AU - Enns, Justine P.
AU - Pollack, Craig E.
AU - Boyd, Cynthia M.
AU - Massare, Jacqueline
AU - Schoenborn, Nancy L.
N1 - Funding Information:
This study was supported from the NIA#T35AG026758 Medical Student Training in Aging Research (MSTAR) Summer Program. Dr. Schoenborn was funded by the K76AG059984 grant from the National Institute on Aging. In addition, Dr. Boyd was supported by 1K24AG056578 from the National Institute on Aging.
Publisher Copyright:
© 2021, Society of General Internal Medicine.
PY - 2022/4
Y1 - 2022/4
N2 - Background: While guidelines recommend against routine screening for breast, prostate, and colorectal cancers in older adults (65+ years) with <10-year life expectancy, many of these patients continue to be screened. How clinicians consider screening cessation across multiple cancer screening types is unknown. Objective: To compare and contrast clinicians’ perspectives on discontinuing breast, prostate, and colorectal cancer screenings in older adults. Design: Qualitative, semi-structured interviews. Participants: Primary care clinicians in Maryland (N=30) Approach: We conducted semi-structured interviews with individual clinicians. Interviews were recorded, transcribed, and analyzed using standard techniques of qualitative content analysis to identify major themes. Key Results: Participants were mostly physicians (24/30) and women (16/30). Four major themes highlighted differences in decision-making across cancer screenings: (1) Clinicians reported more often screening beyond guideline-recommended ages for breast and prostate cancers than colorectal cancer; (2) clinicians had different priorities when considering the benefits/harms of each screening; for example, some prioritized continuing colorectal cancer screening due to the test’s high efficacy while others prioritized stopping colorectal cancer screening due to high procedural risk; some prioritized continuing prostate cancer screening due to poor outcomes from advanced prostate cancer while others prioritized stopping prostate cancer screening due to high false positive test rates and harms from downstream tests; (3) clinicians discussed harms of prostate and colorectal cancer screening more readily than for breast cancer screening; (4) clinicians perceived more involvement with gastroenterologists in colonoscopy decisions and less involvement from specialists for prostate and breast cancer screening. Conclusions: Our results highlight the need for more explicit guidance on how to weigh competing considerations in cancer screening (such as test accuracy versus ease of cancer treatment after detection). Recognizing the complexity of the benefit/harms analysis as clinicians consider multiple cancer screenings, future decision support tools, and clinician education materials can specifically address the competing considerations.
AB - Background: While guidelines recommend against routine screening for breast, prostate, and colorectal cancers in older adults (65+ years) with <10-year life expectancy, many of these patients continue to be screened. How clinicians consider screening cessation across multiple cancer screening types is unknown. Objective: To compare and contrast clinicians’ perspectives on discontinuing breast, prostate, and colorectal cancer screenings in older adults. Design: Qualitative, semi-structured interviews. Participants: Primary care clinicians in Maryland (N=30) Approach: We conducted semi-structured interviews with individual clinicians. Interviews were recorded, transcribed, and analyzed using standard techniques of qualitative content analysis to identify major themes. Key Results: Participants were mostly physicians (24/30) and women (16/30). Four major themes highlighted differences in decision-making across cancer screenings: (1) Clinicians reported more often screening beyond guideline-recommended ages for breast and prostate cancers than colorectal cancer; (2) clinicians had different priorities when considering the benefits/harms of each screening; for example, some prioritized continuing colorectal cancer screening due to the test’s high efficacy while others prioritized stopping colorectal cancer screening due to high procedural risk; some prioritized continuing prostate cancer screening due to poor outcomes from advanced prostate cancer while others prioritized stopping prostate cancer screening due to high false positive test rates and harms from downstream tests; (3) clinicians discussed harms of prostate and colorectal cancer screening more readily than for breast cancer screening; (4) clinicians perceived more involvement with gastroenterologists in colonoscopy decisions and less involvement from specialists for prostate and breast cancer screening. Conclusions: Our results highlight the need for more explicit guidance on how to weigh competing considerations in cancer screening (such as test accuracy versus ease of cancer treatment after detection). Recognizing the complexity of the benefit/harms analysis as clinicians consider multiple cancer screenings, future decision support tools, and clinician education materials can specifically address the competing considerations.
KW - cancer
KW - communication
KW - decision-making
KW - overscreening
KW - screening
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U2 - 10.1007/s11606-021-07121-9
DO - 10.1007/s11606-021-07121-9
M3 - Article
C2 - 34545468
AN - SCOPUS:85115261640
SN - 0884-8734
VL - 37
SP - 1122
EP - 1128
JO - Journal of general internal medicine
JF - Journal of general internal medicine
IS - 5
ER -