Older Patients Advise How to Say: "It's Time to Stop Prostate Cancer Screening"
It's always a challenging conversation to have with patient when discussing the risks and benefits of cancer screening. In my practice, I find following strict age guidelines for all patients does not work. You must look at the individual health of each patient to determine when it is right to offer cancer screening.
NEW YORK (Reuters Health) - When it's time to suggest to older patients that cancer screening is no longer appropriate, they'd rather not hear that they might not live long enough to benefit, a survey shows. Instead, they'd rather be told what guidelines say and be advised to focus on other health issues.
Many older adults who meet thresholds to stop routine screening continue to be tested for breast, prostate, and colorectal cancers.
"There are different ways for a clinician to frame recommendations to stop routine cancer screening, and some messaging approaches are much more preferred by older adults than others. The most preferred messaging approach is to refer to a shift to focus on other health priories," principal investigator Dr. Nancy L. Schoenborn of The Johns Hopkins University School of Medicine in Baltimore, Maryland, told Reuters Health by email.
"Patients mentioned that it would be helpful for clinicians to discuss what alternative health issues would be focused on instead of cancer screening so as to not feel like they were receiving less care," she added.
As reported in JAMA Oncology, online June 28, Dr. Schoenborn and her colleagues conducted a cross-sectional survey using a probability-based online panel representative of U.S. adults. Panel members were recruited by random digit dialing and address-based sampling.
The research team invited 1,272 English speakers, age 65 or older, to participate; 881 (69.3%) completed the survey in 2016. The average age was 73, and 464 (55.2%) were female; 576 (77.2%) were white, non-Hispanic; 216 (8.8%) were African American, non-Hispanic; 47 (8.2%) were Hispanic; and 42 (5.8%) were a different ethnicity or race.
The researchers assessed participants' preferences for 13 different phrases a clinician might use to explain why a patient should not have a routine cancer screening test for breast, prostate, or colorectal cancer.
The phrases for each disease differed only in the terms "mammogram," "prostate-specific antigen (PSA)," or "colonoscopy." Preference scores for the phrases ranged from −1.0 (least preferred) to 1.0 (most preferred).
Using colonoscopy as an example, the most preferred phrase was "Your other health issues should take priority" (mean score 0.41); followed by "Colonoscopy is not recommended for you by medical guidelines"; and "You are unlikely to benefit from the colonoscopy." The least preferred choice was, "The doctor does not give an explanation" (score −0.42); followed by "You may not live long enough to benefit from the colonoscopy"; and "The doctor does not mention colonoscopy."
Dr. Therese Bevers, the medical director of the Cancer Prevention Center at the University of Texas MD Anderson Cancer Center in Houston, said by email, "Having data on how best to communicate about the topic can help increase awareness to discuss it and make the clinician feel more comfortable bringing it up. I hope these results increase discussions with appropriate individuals about the value of discontinuing screening."
Dr. Bevers, who was not involved in the study, cited other reasons adults continue to be screened longer than necessary.
"I believe a major variable is the time it takes to have this discussion. It is often easier to just order the test for next year," she said. "In addition, clinicians have difficulty estimating a '10-year life expectancy' (e.g., an 80-year-old who plays tennis 3 times a week and has no major health issues: order screening or not?)."
"Finally," she added, "clinicians are often out of the loop on screening mammography. According to the Mammography Quality Standards Act (MQSA), women can self-order screening mammograms without a clinician order . . . . Thus a woman of any age can self-order a screening mammogram."
"Clinicians have reported that it is a challenging conversation for them to talk to patients about stopping cancer screening, even though that may be the appropriate decision for some older patients, and this is the first study, to our knowledge, to explore how patients prefer to receive such communications," Dr. Schoenborn said.
"We hope the results can be directly informative for clinicians, who can adapt some of the communication strategies more preferred by older adults into their discussion with their own patients," she advised.
The National Institute on Aging of the National Institutes of Health (NIH) supported the study.
SOURCE: http://bit.ly/2NVvh5A
JAMA Oncol 2018.