Understanding Older Adults' Perspectives on How to Incorporate Life Expectancy in Cancer Screening
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DESCRIPTION (provided by applicant): Cancer is the second leading cause of death among older adults. Cancer screening can lower cancer- related mortality and morbidity but may be associated with significant harms and burdens in older adults. Research has shown that it may take 10 years for people who are screened for cancer to benefit (have lower risk of dying from cancer), compared to those who are not screened. However, harms, including complications and burdens from screening, can occur in the short term. Therefore, cancer screening in older adults with limited life expectancy may inappropriately subject them to harm with they are unlikely to live long enough to benefit. Compared to younger populations, older adults of the same age can be much more heterogeneous in their health status and life expectancies. Older adults with very limited life expectancy are still frequently screened for cancer. Healthy older adults with relatively long life expectancies-who may still benefit from cancer screening-are under-screened. Therefore, it is critically important to communicate and incorporate life expectancy in cancer screening among older adults so that individualized risks and benefits of screening are presented for patients to make informed decisions aligned with their preferences. How to best communicate and incorporate life expectancy in cancer screening of older adults is not well- defined. Multiple tools incorporating individuals' functional status and co-morbidities have been developed to predict life expectancy among older adults. However, it is not clear how frequently or how appropriately these tools are used in clinical practice. One barrier to their uptake is that clinicians have difficulty discussing life expectancy with their older patients. Clinicians lack a clear understanding of older adults' preferences for talking about life expectancy in cancer screening. In this context, it is essential to better understand how older adults perceive the role of life expectancy in cancer screening and what their preferences are for life expectancy communication with their clinicians in the screening context. This proposal fills an important research gap by aiming to better understand older adults' preferences regarding how to communicate and incorporate life expectancy in cancer screening. Because little is known about this area, we will first use a qualitative in-depth study to understand the range of patient perspectives in Aim 1; we will then determine the applicability of these perspectives in a larger, nationally representative population in Aim 2. This innovative work addresses the knowledge gap in understanding older adults' preferences for how to communicate and incorporate life expectancy in cancer screening. The proposed project will provide the much needed empiric data to inform the development of best practices and interventions to improve individualized, patient-centered cancer screening for older adults.
