Psychosocial and clinical predictors of continued cancer screening in older adults

Jenna Smith; Rachael H Dodd; Jolyn Hersch; Kirsten J McCaffery; Vasi Naganathan; Erin Cvejic; Jesse Jansen

doi:10.1016/j.pec.2021.04.027

Psychosocial and clinical predictors of continued cancer screening in older adults

Patient Educ Couns. 2021 Dec;104(12):3093-3096. doi: 10.1016/j.pec.2021.04.027. Epub 2021 Apr 30.

Authors

Jenna Smith¹, Rachael H Dodd², Jolyn Hersch², Kirsten J McCaffery², Vasi Naganathan³, Erin Cvejic⁴, Jesse Jansen⁵

Affiliations

¹ Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, Australia; Sydney Health Literacy Laboratory, Sydney School of Public Health, The University of Sydney, Sydney, Australia. Electronic address: jenna.smith@sydney.edu.au.
² Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, Australia; Sydney Health Literacy Laboratory, Sydney School of Public Health, The University of Sydney, Sydney, Australia.
³ Centre for Education and Research on Ageing, Concord Clinical School, The University of Sydney, Sydney, Australia.
⁴ Sydney Health Literacy Laboratory, Sydney School of Public Health, The University of Sydney, Sydney, Australia.
⁵ Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, Australia; Sydney Health Literacy Laboratory, Sydney School of Public Health, The University of Sydney, Sydney, Australia; School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.

PMID: 33962825
DOI: 10.1016/j.pec.2021.04.027

Abstract

Objective: Many older adults (aged 75+) continue cancer screening despite guidelines suggesting they should not. Using mixed-methods, we examined psychosocial and clinical factors associated with continued breast/prostate screening.

Methods: We conducted an online, scenario-based, randomized study in Australia with participants aged 65+ years. The primary outcome was screening intention (10-point scale, dichotomized: low (1-5) and high (6-10)). We also measured demographic, psychosocial, and age-related clinical variables. Participants provided reason/s for their screening intentions in free-text.

Results: 271 eligible participants completed the survey (aged 65-90 years, 71% adequate health literacy). Those who reported higher cancer anxiety, were men, screened more recently, had family history of breast/prostate cancer and were independent in activities of daily living, were more likely to intend to continue screening. Commonly reported reasons for intending to continue screening were grouped into six themes: routine adherence, the value of knowing, positive screening attitudes, perceived susceptibility, benefits focus, and needing reassurance.

Conclusions: Psychosocial factors may drive continued cancer screening in older adults and undermine efforts to promote informed decision-making.

Practice implications: When communicating benefits and harms of cancer screening to older adults, both clinical and psychosocial factors should be discussed to support informed decision-making.

Keywords: Breast cancer screening; Informed decision-making; Older adults; Overdiagnosis; Prostate cancer screening.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Activities of Daily Living
Aged
Decision Making
Early Detection of Cancer*
Humans
Male
Mass Screening
Prostatic Neoplasms* / diagnosis