Multimorbidity and Cancer Screening: Achieving Patient Understanding

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DESCRIPTION (provided by applicant): The U.S. Preventive Services Task Force recently recommended against routine colorectal cancer (CRC) screening for those age 75 and older because on average the risks outweigh the benefits. These recommendations are supported by the ongoing research of the two teams collaborating on this application. However, the idea of stopping cancer screening opposes years of public health messages that emphasize the need for cancer screening. Understandably, older adults with multimorbidity may be confused by this new message and will need to understand the rationale behind the decision not to perform CRC screening to avoid feelings of abandonment or ageism. It is currently not known how to best present information to older patients about the net harm of CRC screening so that these difficult concepts are understood and accepted. The overall goal of the proposed research is to determine how to present CRC screening information to individual patients who are likely not to benefit from screening. This goal will be accomplished with the following aims: Aim 1: To conduct qualitative interviews of older persons with multimorbidity to explore their attitudes about not undergoing cancer screening due their health status. Aim 2: To use the qualitative data to refine two different written educational tools with messages relaying that the patient will unlikely benefit from screening. One approach will be based the Yale approach of payoff time. The second approach will be based on the UNC approach that the risks outweigh the benefits in patients with multi-morbidities. Aim 3: To test the two different educational tools in a sample of 100 patients age 75+ or age 70 with 2 chronic conditions from three primary care settings for understanding, perceived insensitivity, and whether, after exposure to each tool, they would want to undergo screening. The recent U.S. Preventive Task Force Recommendations and both UNC and Yale's independent modeling studies will identify a significant proportion of the population who will likely not benefit from CRC screening. The need to educate this targeted population is urgent to avoid a potential backlash against these recommendations. The proposed application will bring together two research teams who have performed much of the formative research for CRC screening in patients with multimorbidities. In the proposed research, they will determine the optimal content of an educational tool for CRC screening in older adults with multi-morbidities who would not benefit from screening. This will directly lead to additional studies to test the educational tool in the clinical setting.