Johns Hopkins geriatrician Nancy Schoenborn discusses her research regarding cancer screening decisions for older adults and the importance of considering each patient’s health status, life expectancy and preferences when deciding if and when to stop screening.
mm hmm. Okay. Hi, my name is Nancy Schoenborn. I'm an associate professor of medicine at johns Hopkins University School of Medicine in the division of geriatric medicine and gerontology. As a primary care physician, I care for adults 65 years and older who often have complex multiple chronic conditions. Many of them often have functional impairment, cognitive impairment or frailty. These are the patients that I have in mind in my research as a health services researcher. My research goal is to tailor the care we provide to each individual where we consider each patient's health status, life expectancy and preferences. Specifically, I have focused on cancer screening decisions in patients with serious illness. Cancer screening can divert attention and resources away from the more important health priorities, exposing patients to harms without expanding their life or providing much benefit. I have explored how patients and clinicians consider the benefits and harms of cancer screening to decide if and when it may be appropriate to stop screening. These can be difficult decisions and tough conversations to have. So my research has also focused on how patients prefer to have these conversations. We have learned valuable lessons from both the patient studies and clinician studies in two studies published in the journals of Jama Internal Medicine and Jama Oncology, we found that older adults can be amenable to stopping screening in the context of a trusting relationship. However, how that information is presented to them can be very important for example, to say to someone that they don't need another colonoscopy because we need to focus on the more important health priorities was more preferable to older adults than to say that they don't need another colonoscopy because they're not gonna live long enough to benefit. These results can be helpful for clinicians as they have their own discussion with patients and inform public health policy and guidelines to make sure that the words we use in general are thoughtful and resonate with patients. In parallel studies. We looked at clinician perspectives and these are studies that were published in the journals of Jama Network Open and the Journal of American Geriatrics Society. We found that primary care clinicians often did consider and take into account their patients preferences. Life expectancy and health status, which are recommended in the guidelines, but we also found that they had concerns and considerations not currently included in the guidelines. For example, clinicians were concerned whether using life expectancy to decide about cancer screening might inadvertently introduce bias or lead to unintended consequences. They also raised the issue that how can we better measure more intangible benefits of cancer screening, such as reassurance to a patient who is very anxious about cancer risk. These results can help inform future research and make sure that the guidelines eventually will be more salient to both clinicians on the frontline and patients alike. In summary. The most insightful research is when we listen to the voices of the frontline clinicians and patients alike. Working together, we can move towards care that is more individualized and patient centered for older adults, especially those who may be frail or have complex medical conditions. Yeah.
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