Stopping Elders' Cancer Screening

The risk-benefit ratio of cancer screening shifts over time. What's the best way to present to patients that they can stop screening because at their age the risks outweigh the benefits?

A Journal of the American Medical Association (JAMA) qualitative interview study led to the conclusion that "the way clinicians deliver the message matters." 

The study indicated patients were "generally were amenable to the idea of stopping screening." Understandably, it was the mention of life expectancy that seemed to cause problems. "Some were skeptical of the accuracy of the predicted life expectancy; others thought the information could be depressing."

Many patients don't realize the benefit of screening is tied to life expectancy. It would be cruel to tell patients, "You may not live long enough to benefit from this test." The article suggests a compassionate way of saying the same thing: "This test would not help you live longer."

It may help to normalize stopping screening as part of optimal personalized care. "Every time we have ever made a decision about a test or treatment, we have balanced the risks and benefits for you. From now on, we will continue to follow you without the risk of those screening tests. This is in keeping with our motto to "First do no harm." 

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