Psychosocial and clinical predictors of continued cancer screening in older adults |
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| Affiliation: | 1. Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, Australia;2. 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. School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands;1. Austrian Public Health Institute, Department Health Literacy and Health Promotion, Vienna, Austria;2. Austrian Health Literacy Alliance, c/o Austrian Health Promotion Fund, Vienna, Austria;3. Institute of Health Promotion and Disease Prevention, Graz, Austria;4. FH Joanneum University of Applied Sciences, Health and Tourism Management, Bad Gleichenberg, Austria;5. University of Iowa, Carver College of Medicine, Iowa City, USA;1. Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands;2. Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands;1. Dr. Laurie Sands Distinguished Professor of Families & Health, Departments of Psychiatry & Family Medicine, University of Rochester School of Medicine, Rochester, NY, USA;2. Associate Professor of Psychiatry and Medicine, University of Rochester School of Medicine, Rochester, NY, USA;3. Associate Professor of Emergency Medicine, University of Rochester School of Medicine, Rochester, NY, USA;4. Equilibria Psychological and Consultation Services, Philadelphia, PA, USA;5. Private Practice, New York City, NY, USA;6. Professor of Internal Medicine, Hematology & Oncology Division, University of Michigan, Ann Arbor, MI, USA;7. Professor of Marriage & Family Therapy, Purdue University, West Lafayette, IN, USA;8. Professor of Medical Education, Faculty of Medicine, Hebrew University/Hadassah, Jerusalem, Israel;1. The Third Xiangya Hospital of Central South University, Department of Hematology, Changsha, China;2. The Third Xiangya Hospital of Central South University, Department of Clinical Psychology, Changsha, China;3. The Third Xiangya Hospital of Central South University, Department of Medical Administration, Changsha, China;1. Department of Medical Social Sciences, Northwestern University, Chicago, IL 60611, USA;2. Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL 60611, USA;3. Department of Pediatrics, University of North Carolina, Chapel Hill, NC 27599, USA;4. Department of Genetics, University of North Carolina, Chapel Hill, NC 27599, USA;5. Department of Biostatistics, University of North Carolina, Chapel Hill, NC 27599, USA;6. U.S. Government Accountability Office, 441G Street NW, Washington, DC 20548, USA;7. Department of Health Behavior, University of North Carolina, 135 Dauer Dr., Chapel Hill, NC 27599, USA;8. Department of Social Medicine, University of North Carolina, Chapel Hill, NC 27599, USA |
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| Abstract: | ObjectiveMany 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.MethodsWe 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.Results271 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.ConclusionsPsychosocial factors may drive continued cancer screening in older adults and undermine efforts to promote informed decision-making.Practice implicationsWhen communicating benefits and harms of cancer screening to older adults, both clinical and psychosocial factors should be discussed to support informed decision-making. |
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| Keywords: | Older adults Breast cancer screening Prostate cancer screening Overdiagnosis Informed decision-making |
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