Communicating With Older Patients About the Need for Breast Cancer Screening
Posted: Thursday, July 25, 2019
Primary care clinicians often worry that their elderly patients will be distressed by advice to stop cancer screenings such as mammograms, but this concern turns out to be unfounded, according to a new qualitative study. The older adults in the study did not report negative reactions to such advice if they had a trusting relationship with their clinician. The study was published in The Gerontologist by Nancy L. Schoenborn, MD, MHS, of Johns Hopkins University School of Medicine, and colleagues.
“I hope that’s reassuring for doctors,” said Dr. Schoenborn in a Johns Hopkins press release, “and makes them a little bit more comfortable going into these conversations.”
The researchers interviewed 28 primary care clinicians (physicians, PAs , and NPs) and 40 patients between the ages of 65 and 92 on how they felt about communication around stopping cancer screening, including mammograms. Of the patients, 62.5% were white, and 35% were African American. Clinicians were all drawn from one large group practice.
Clinicians and patients agreed that it was important to involve patients in the decision, to discuss both the risks and benefits of cancer screening, and to frame the change as a shift in which health issues are priorities. Patients said it would be helpful to talk about what other health issues would be prioritized instead of cancer screening. Patients said things like “I would trust in what she’s recommending” if the doctor advised stopping cancer screening.
Some older patients wanted their clinicians to discuss life expectancy in this discussion, some were neutral about such a talk, and still others actively did not want to discuss life expectancy. “Given the heterogeneity in older adults’ preferences, it is important to explore which patients want to know and discuss life expectancy information in the context of cancer screening,” the investigators suggested.
Disclosure: The study authors reported no conflicts of interest.