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This article has been peer reviewed. It is the authors' final version prior to publication in Population Health Management, Volume 22, Issue 4, August 2019, Pages 315-320.

Final publication is available from Mary Ann Liebert, Inc., publishers


Introduction: Cancer-screening decisions for older adults should be individualized. However, conducting such complex shared decisions may be challenging for primary care providers (PCPs). Additionally, there is little information on how PCPs make these decisions. This study consisted of a provider survey and chart review to assess current PCP approaches to breast and colorectal cancer (CRC) screening with patients age ≥75.

Methods: PCP survey questions: panel age, comfort with discussion of screening harms and benefits, screening decision-making process, and discussion style. One Hundred charts were chosen from a random sample of male and female patients ≥75 with a recent office visit. Chart reviews assessed whether providers recommended screening for breast and/or colon cancer in patients ≥75, if there was a documented screening discussion, and if screening was completed.

Results: Fifty-one PCPs completed the survey. PCPs varied in the proportions of older adults they recommended for breast and CRC screening. 90.2% reported feeling very (43.1%) or somewhat (47.1%) comfortable discussing reasons for/against screening with older patients. Top screening considerations: life expectancy (84.3%), patient preference (82.4%), and severity of medical conditions (70.6%). Three-quarters (74.55%) reported a shared decision-making approach with discussion of harms/ benefits. Of 61 eligible patients, 8(13.1%) had a documented discussion regarding mammography. Of 58 patients eligible for CRC screening, 7(12.1%) had a documented discussion.

Discussion: Findings showed inconsistency in PCP approaches to cancer screening in older adults and in discussion documentation. There is ample room for improvement in standardizing approaches and documentation of cancer screening discussions with older patients.

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