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Review
. 2016 May;31(5):539-47.
doi: 10.1007/s11606-016-3629-y. Epub 2016 Mar 3.

An Individualized Approach to Cancer Screening Decisions in Older Adults: A Multilevel Framework

Erica S Breslau  1 , Sherri Sheinfeld Gorin  2   3 , Heather M Edwards  4 , Mara A Schonberg  5 , Nicole Saiontz  6 , Louise C Walter  7
Affiliations
Review

An Individualized Approach to Cancer Screening Decisions in Older Adults: A Multilevel Framework

Erica S Breslau et al. J Gen Intern Med. 2016 May.

Abstract

Guidelines for optimal cancer screening in older adults remain unclear, particularly for adults over the age of 75. While cancer screening in older adults may benefit some in good health, it may cause unnecessary burdens in others with limited life expectancy. Thus, a systematic approach to enable individualized cancer screening decisions in older adults is needed. We suggest a framework that guides such decisions through evidence-based approaches from multiple interactions, and that involves the patient, clinician, and healthcare system. An individualized approach considers differences in disease risk rather than the chronological age of the patient. This paper presents a comprehensive framework that depicts the independent and converging levels of influences on individualized cancer screening decisions in older adults. This Individualized Decisions for Screening (IDS) framework recognizes the reality of these interrelationships, including the tensions that arise when behaviors and outcomes are valued differently at the patient, clinician, and healthcare organization levels. Person-centered approaches are essential to advancing multilevel research of individualized cancer screening decisions among older adults.

Keywords: Framework; Geriatric; Individualized screening; Multilevel; Shared decision making.

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Conflict of interest statement

Drs. Breslau, Schonberg, and Walter and Ms. Saiontz do not have a conflict of interest with consultancies, employment, honoraria, stock ownership, expert testimony, grants, patents or royalties. Drs. Edwards and Sheinfeld Gorin were employed by Leidos Biomedical Research, Inc., as contractors supporting the National Cancer Institute. Dr. Edwards is currently employed by the Patient-Centered Outcomes Research Institute and Dr. Sheinfeld Gorin by New York Physicians against Cancer, Herbert Irving Comprehensive Cancer Center, New York, NY.

Figures

Figure 1.
Figure 1.
Individualized Decisions for Screening of Older Adults (IDS). Arrows indicate the direction of causality. Solid lines denote the link between outcomes resulting from an individualized decision and a link to an outcome stemming from the patient, clinician, and healthcare organization. Dotted lines specify an intermediate or distal outcome whereby individual patients cycle back to Decisional Factors should a new test or retesting be ordered by a clinician.
See this image and copyright information in PMC

References

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