Decisions about Medication Use and Cancer Screening Among Elderly Adults in the United States
DECISIONS ABOUT MEDICATION USEAND CANCER SCREENING AMONGELDERLY ADULTS IN THE UNITEDSTATESFairfield KM, Gerstein B, Levin CA, McNaughton-Collins M
BACKGROUND¢ Elderly adults frequently encounter medicaldecisions, yet little is known about the processand quality of these decisions.¢ Improved decision making about medication useand cancer screening may have relevance inpreventing harm from: over-screening over-treatment polypharmacy
TRENDS STUDY DESIGN¢ The TRENDS study is a survey of adults aged 40 andover in the US conducted in 2011 via an Internetpanel.¢ A decision for the purposes of this study includeswhether the respondent had or discussed having acancer screening test (breast, prostate, or colorectalcancer) or whether the respondent started or stopped,or discussed starting or stopping a medication forhypertension, cholesterol, or depression within thepast two years.¢ Respondents who made either one or two of thetargeted medical decisions were asked a series ofquestions about each decision. Respondents whomade three or more of the targeted medical decisionswere asked about the two that are the least commonbased on U.S. prevalence rates.
DECISION PROCESS AND VALUE SCORES¢ Respondents were queried about: decision process (such as whether pros and cons wereaddressed, whether their opinion was sought, andwho made the final decision) knowledge about the treatment, decisional regret,and perceived benefit and costs (including sideeffects, out of pocket costs, having to take medication,false alarms, and having to deal with a cancer thatmight not cause any harm)
ANALYSES¢ Age was the primary variable of interest <60, 60-74, 75+ Decided on 75+ as the elderly group because ofscreening guidelines and face validity for competingrisks discussion Sample size tradeoff for 75+ group¢ Results presented only for respondents who werescreened/ took medications¢ ANOVA to analyze data as appropriate¢ Mainly descriptive statistics
RESULTS¢ # of respondents ranged from 271-894 across 5topics 40-60% across topics were aged <60 32-51% across topics were aged 60-74 8-16% across topics were aged 75+¢ Decision process scores were similar (andgenerally low) across age groups for medicationand cancer screening indicates that all groups had poor involvement inmedical decision making The most aged (75+) respondents with 1+ risk factorfor heart disease had significantly lower decisionprocess scores (p=0.02)
RESULTS¢ Knowledge about medications was higher thanfor screening tests, yet did not vary significantlyby age.¢ All age groups tended to place positive value onpotential benefits of screening and medication¢ All age groups averaged 8+ (scale 0-10) on importance ofpotential screening benefits (e.g., finding cancer early)¢ All age groups averaged 9+ (scale 0-10) on importance ofpotential medication benefits (e.g., lowering risk of heartattack)
RESULTS¢ The most aged (75+) respondents reported:¢ For CRC screening:¢ Less discomfort with handling stool¢ Less concern about annual testing¢ For Breast cancer screening¢ Greater importance of peace of mind (after normal)¢ For Medications:¢ Less importance of minimizing out of pocket costs¢ Less importance of avoiding taking cholesterol meds¢ Surprisingly little concern about avoiding side effects
CONCLUSIONS¢ Elderly respondents to this national survey reportweak decision processes when facing choices aboutcommon medications and cancer screening¢ This is despite: little evidence of benefit for some interventions (cancerscreening, cholesterol lowering medicines in low riskelderly) possibility of harm (overdiagnosis, overtreatment, andpolypharmacy in elders)¢ Opportunity to educate elders and medicalprofessionals who care for them when consideringcancer screening and adding medications:¢ estimated benefits¢ competing risks
DISCUSSION¢ Questions about findings to date?¢ Additional analyses this group can suggest?¢ Emphasis area for manuscript?