How do older patients react to the idea of stopping cancer screening toward the end of life?

It seems that we don't want to be reminded that we are approaching what Harlan Ellison calls "the downhill side" of life. When bringing up the idea that cancer screening may no longer be beneficial given a patient's limited life expectancy, using direct language such as "You may not live long enough to benefit from this test" is perceived by many patients as overly harsh. Instead, statements such as "This test will not help you live longer" may be better received. Although not studied, this same approach may be helpful for de-prescribing efforts. (LOE = 4)

Schoenborn NL, Lee K Pollack CE, et al. Older adults' views and communication preferences about cancer screening cessation. JAMA Intern Med 2017;177(8):1121-1128.  [PMID:28604917]

Cohort (prospective)

Government

Outpatient (any)

Many guidelines, such as those from the Choosing Wisely campaign, suggest stopping screening for cancer at an age when early identification is not likely to produce a net benefit. This study enrolled 40 patients, with an average age of 75.7 years, to collect their thoughts about how the topic of stopping screening should be broached. Individuals were interviewed after they were given a brief overview of the benefits and harms of cancer screening, using common cancers as examples. They were also told that someone who will not live for 10 more years might not benefit and might be harmed by screening. Patients were then asked what factors they would consider to stop getting regular screening, and what their reactions would be if a clinician suggested stopping screening. Patients were interviewed by an investigator not known to them and the interviews were recorded, transcribed, and open-coded to identify themes. Transcripts were coded independently by 2 investigators. Three themes emerged: (1) participants were amenable to stopping cancer screening, especially if suggested by a trusted clinician; (2) they objected to the concept that a clinician could accurately predict life expectancy; and (3) they preferred that a clinician explain a recommendation to stop screening by incorporating individual health status, but were divided as to whether life expectancy should be brought into the discussion.