Objectives Older adults continue to be screened for cancer with limited knowledge of the potential hams. In Australia, general practitioners (GPs) may play an important role in communication and decision-making around cancer screening for older people. The aim of this study was to investigate GP’s attitudes and behaviours regarding cancer screening (breast, cervical, prostate and bowel) in patients aged ≥70 years (given that national breast and cervical screening programs only recently extended to target women aged 70–74).
Method Semi-structured interviews were conducted with GPs practising in Australia (n=28). Participants were recruited through multiple avenues to ensure variation in experience and geographic location (e.g., practice-based research networks, primary health networks, professional newsletters, social media, cold calling/emailing). Transcribed audio-recordings were analysed thematically.
Results Some GPs only initiated screening discussions with patients younger than what they understood to be the upper targeted age of screening programs (i.e., 69 or 74 years). Others initiated discussions beyond recommended ages. When providing information, some GPs believed patients would need to pay to access breast screening, some were uncomfortable discussing why screening reminders stop, and detailed benefit and harms discussions were more likely for prostate screening. GPs described patients who were obliging, insistent on continuing/stopping, and those who were offended they were not invited anymore. When navigating patient-initiated discussions, GPs tailored their response to why the older person desired the screening test, but ultimately the patient had the final say. GPs considered the patient’s overall health/function, risk, previous screening experience, and the reassurance needed as factors in whether screening was worthwhile in older age.
Conclusions There is no uniform approach to cancer screening communication and decision-making for older adults in general practice. Given the role of patient preference, as well as the limited understanding around why screening has an upper age for invitations, tools to support effective communication of the reduced benefit and increased chance of harm from cancer screening in older age may help support older people to make more informed screening choices.
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