Blog | Thursday, March 14, 2013

QD: News Every Day--It's tough to convince older patients not to undergo screening


It's tough to tell seniors not to undergo screening, researchers found, and physicians who discourage unneeded tests may face resistance or disbelief when they do.

"These attitudes are similar to those seen in Americans more generally; most Americans surveyed see screening as an undisputed good and fail to recognize how screening tests can be harmful or nonbeneficial," the authors wrote. "Positive attitudes may help motivate individuals to undergo screening when their health status or age makes screening tests beneficial, but when they are older or ill, these same attitudes and limitations in understanding may make it hard for them to accept recommendations to stop screening."

To learn about older adults' perspectives on stopping screening cessation and their talks with clinicians about this topic, researchers interviewed 33 older adults (median age, 76; range, 63 to 91) presenting to a senior health center affiliated with an urban hospital. Results appeared online at JAMA Internal Medicine.

Interviewers started with open-ended questions about patient perceptions and recent experiences with screening decisions, and then outlined a list of potential decision-making factors, such as physician recommendations, statistical data about the test, and hypothetical conditions such as living in a nursing home. Interview transcripts were analyzed to identify themes and illustrative quotes.

Some patients see screening tests as morally obligatory. One 84-year-old woman told interviewers, "I think I should, because [stopping] would be the same as me taking my life. And that's a sin."

Some patients also see screening tests as mandatory. Another 91-year-old woman said, "Whenever we were told we were supposed to do something, I just, you know, did it."

Others accepted the need for screening with little discussion by physicians.

Researchers summarized that many patients saw continuing screening as a default decision, and stopping screening as a major one. Some patients were upset or expressed disbelief when physicians recommended stopping, and said they would get a second opinion.

Still more lacked confidence in government panels and recommendations, or in the need for statistics as part of a decision-making process. They were more agreeable about stopping because of the balance of risks and benefits, complications or test burdens.

Researchers concluded, "Just as the public health and medical message to patients is that screening is a wise and admirable choice when they are middle aged and otherwise healthy, so must messages explain why not screening, and focusing on other aspects of care, may be wise and admirable when patients are older or ill."