Discussing Stopping Cancer Screening and Prognosis With Older Adults
Condition: Cancer Screening
Study type: Interventional

Summary: 
      Guidelines recommend not screening adults with <10-year life expectancy for cancer; however,
      primary care physicians feel uncomfortable talking to older adults about prognosis. The
      investigators aim to determine whether providing PCPs with scripts on patient prognosis and
      older adults with information on their prognosis would be useful when recommending stopping
      cancer screening.
    

Detailed description: 
      The American Cancer Society and the American Board of Internal Medicine Choosing Wisely
      Campaign recommend clinicians not screen older adults who have <10 year life expectancy for
      breast (specific to women) or colorectal cancer (CRC). This is because these patients have
      little chance of experiencing the life prolonging benefits of cancer screening and instead
      may only experience harm from being screened. The most concerning harm of cancer screening is
      overdiagnosis - the diagnosis and treatment of cancers that otherwise would not have caused
      problems in an older adult's lifetime. Despite this, around half of adults >75 years with <10
      year life expectancy are regularly screened for cancer. One reason for the overuse of these
      tests is that PCPs feel uncomfortable discussing stopping screening with older adults since
      it requires estimating and discussing patient prognosis. Some PCPs admit to recommending
      cancer screening to older adults with short life expectancy simply to avoid talking to
      patients about prognosis. However, by avoiding these discussions, PCPs may be impeding older
      adults' ability to make informed decisions about their care and may be putting patients at
      risk of the harms of cancer screening without any chance of benefit. Therefore, the
      investigators aim to interview PCPs and older adults about their thoughts and feelings on how
      PCPs may discuss older adults' prognosis in the context of talking about stopping cancer
      screening. Based on those findings, the investigators will develop strategies for PCPs to use
      to approach these discussions and will draft scripts to suggest language for PCPs to use when
      communicating about prognosis when recommending stopping cancer screening. Then, the
      investigators will study if providing PCPs with these scripts and information about their
      patients' prognosis is useful. Specifically, the investigators will provide 45 PCPs with
      information about their patients' prognosis and the example scripts before a clinic visit for
      up to 5 of their patients. The investigators aim to recruit 90 patients with approximately
      5-10 year life expectancy. The investigators will interview PCPs and older adults after these
      visits to learn how and/or if the prognostic information and the scripts were used. These
      data are essential for improving the quality of PCP discussions around stopping cancer
      screening and will ultimately improve the care of older adults.

      Specific Aims:

        1. To learn from PCPs and older adults about how to discuss patient prognosis when
           recommending stopping cancer screening and to develop strategies for having these
           discussions.

        2. To study whether providing information on patient prognosis and scripts for discussing
           patient prognosis when recommending stopping cancer screening are useful to PCPs and
           older adults.
    

Intervention name(s): Prognosis information and Provider Scripts
Intervention type(s): Other
Intervention description(s): An individualized report including each patient's prognosis will be calculated by the Lee-Schonberg and will include information on patient life expectancy from Cho et al.'s US life tables. This report will be sent to the PCP three days before the patient visit. Example scripts for PCPs to use with patients when discussing life expectancy and stopping cancer screening will be sent with the patient prognostic information.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: Life expectancy; Older adults; Primary care; Cancer screening