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Seniors may not see logic of halting cancer screenings

Monday March 11, 2013
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Many older adults are hesitant to halt cancer screenings even when the screenings may no longer be beneficial or may even be harmful, according to a study.

The study, conducted by researchers with the Regenstrief Institute and the Indiana University Center for Aging Research, is described as one of the first to explore older adultsí perceptions of recommendations to halt screenings for breast, prostate, colon and other cancers as they age.

The researchers — led by Regenstrief Institute investigator Alexia Torke, MD, an IU Center for Aging Research scientist and an assistant professor of medicine at the IU School of Medicine — reported that many older adults feel a strong moral obligation to continue cancer screenings and that a physicianís recommendation to stop screening might threaten trust in the doctor or motivate the patient to seek a second opinion.

"In this era of attention to over-testing, there is a growing recognition in the medical community that some older adults are screened for cancer when it is not beneficial or is even potentially harmful to that person," Torke said in a news release. "If physicians are going to successfully communicate with older patients about forgoing screening, they, as well as other care providers, need to understand how older adults view these screenings."

In open-ended interviews with older adults whose average age was 76, the researchers found patients viewed screening as an automatic, recommended or obligatory action. According to Torke, this finding confirms the success of public health campaigns in communicating the health benefits of screening. The study findings, she said, highlight the need to develop specific messages for older adults that do not undermine the messages targeted to other groups.

However, study participants seemed to respond well to the idea that screening does not make sense if the burdens — such as pain, time requirements or stress — can be expected to outweigh the benefits. For example, the burdens of colonoscopy were repeatedly cited as reasons not to continue with this test as the patient aged.

Participants were skeptical about hearing government panel recommendations and statistics that show older adults may not benefit from certain screening tests. Many expressed distrust of the government or felt statistics did not apply to them.

Study participants ranged in age from 63 to 90.

"Each patient is different, but when speaking with older adults or the caregivers of those who can no longer make decisions for themselves about reducing screenings, the discussion needs to clearly outline the balance of risks and benefits for the specific individual," Torke said. "This approach has the greatest chance of building trust and understanding."

The study was published March 11 on the website of JAMA Internal Medicine (formerly the Archives of Internal Medicine), and is available at http://archinte.jamanetwork.com/article.aspx?articleid=1666431.


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