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Clinician Perspectives on Overscreening for Cancer in Older Adults With Limited Life Expectancy
Author(s) -
Schoenborn Nancy L.,
Massare Jacqueline,
Park Reuben,
Pollack Craig E.,
Choi Youngjee,
Boyd Cynthia M.
Publication year - 2020
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.16415
Subject(s) - medicine , life expectancy , guideline , family medicine , population , medline , gerontology , pathology , environmental health , political science , law
BACKGROUND/OBJECTIVES Guidelines recommend against routine screening for breast, colorectal, and prostate cancers in older adults with less than 10 years of life expectancy. However, clinicians often continue to recommend cancer screening for these patients. We examined primary care cliniciansʼ perspectives regarding overscreening, as defined by limited life expectancy. DESIGN Semistructured, in‐depth individual interviews. SETTING Twenty‐one academic and nonacademic primary care clinics in Maryland. PARTICIPANTS Thirty primary care clinicians from internal medicine, family medicine, medicine/pediatrics, and geriatric medicine. MEASUREMENTS Interviews explored whether the clinicians believed that overscreening for breast, colorectal, or prostate cancers existed in older adults and their views on using life expectancy to decide on stopping routine screening. Audio recordings of the interviews were transcribed verbatim. Two investigators independently coded all transcripts using qualitative content analysis. RESULTS Most clinicians were physicians (24/30) and women (16/30). Content analysis generated three major themes. (1) Many, but not all, clinicians perceived overscreening in older adults as a problem. (2) There was controversy around using limited life expectancy to define overscreening due to concerns that the guidelines did not capture potential nonmortality benefits of screening; that population‐based screening data could not be easily applied to individuals; that this approach failed to account for patient choice; and that life expectancy predictions were inaccurate. (3) Some clinicians worried that using life expectancy to define overscreening may inadvertently introduce bias and lead to unintended harms. CONCLUSIONS Several clinicians disagreed with guideline frameworks of using limited life expectancy to guide cancer screening cessation. Some disagreement stems from inadequate knowledge about the benefits and harms of cancer screening and indicates a need for education or decision support. Other reasons for disagreement highlight the need to refine the current recommended cancer screening approaches and identify strategies to avoid unintended consequences, such as introducing bias or exacerbating existing disparities. J Am Geriatr Soc 68:1462‐1468, 2020.