Table 1.

Steps for consideration and discussion when deciding if your older patient would benefit from screening

Determining whether to discuss screening with older patients
  • Requests for continued screening will come from patients or relatives

  • Omitting discussion about cancer screening is not preferred by older patients1

  • Family physicians should be prepared to discuss screening decisions with older patients

  • Older patients might be confused about the difference between screening and monitoring of existing health conditions

Clinical practice guidelines often recommend against screening in older patients based on a specific age or life expectancy

Clinical trials on screening used to develop practice guidelines do not typically include people aged > 75 y
Determining if older patients might benefit from screening
  • Patient life expectancy is an important consideration in deciding on the potential benefits and harms of screening

  • Family physicians should estimate individual life expectancy based on unique patient circumstances to aid in decision making on screening

  • Older patients will have a range of life expectancies depending on comorbidity.6 Each age group will include patients who might or might not benefit from screening (Table 2)79

  • Other issues that should be considered include health status, frailty,4 and individual patient values and preferences

Benefits from screening occur downstream while harms typically occur immediately after screening

Patients with life expectancy > 5–10 y have the potential to benefit from some screening interventions
Discussing screening
  • Some older patients might not consider life expectancy an important issue and might prefer not to have a discussion on screening framed by their life expectancy—although all of us older than 50 are aware that no one gets out of here alive!

  • Use of health status is a preferred approach to framing discussions about screening in older patients

Appropriate framing of discussions is important in developing individualized screening decisions (Box 1)10
Identifying patients who would probably not benefit from screening
  • The most preferred explanation is a priority shift to other health care issues. Consider this script: “Your other health issues should take priority. This test is unlikely to help you live longer or better”

  • Confidence in their physician is an important factor in patients’ acceptance of recommendations to stop screening

Decision aids that explain the benefits and risks of screening in a manner more easily understood by patients (using absolute risk and natural frequencies) can be used to support shared decision making
Identifying patients who have the potential to benefit from screening
  • Patients should be aware of the lack of evidence to support the benefits of screening into advanced age

  • Discussions should include both the potential harms and benefits of any screening intervention

  • Patients should be informed about the implications of positive test results, such as further tests or interventions that could cause harm