Decision Making and Counseling around Mammography Screening for Women Aged 80 or Older

Authors

  • Mara A. Schonberg MD, MPH,

    1. Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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  • Radhika A. Ramanan MD, MPH,

    1. Director of Faculty Development, Long Beach Memorial Medical Center, University of California, Irvine, CA, USA.
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  • Ellen P. McCarthy PhD, MPH,

    1. Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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  • Edward R. Marcantonio MD, SM

    1. Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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  • The authors have no conflicts of interest to declare.

  • This paper was presented in part at the 2005 National Meeting of the Society of General Internal Medicine, May 13, 2005, New Orleans, LA.

Address correspondence and requests for reprints to Dr. Schonberg, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Yamins 111A, Boston, MA 02215 (e-mail: mschonbe@bidmc.harvard.edu).

Abstract

BACKGROUND: Despite uncertain benefit, many women over age 80 (oldest-old) receive screening mammography.

OBJECTIVE: To explore decision-making and physician counseling of oldest-old women around mammography screening.

DESIGN: Qualitative research using in-depth semi-structured interviews.

PARTICIPANTS: Twenty-three women aged 80 or older who received care at a large academic primary care practice (13 had undergone mammography screening in the past 2 years) and 16 physicians at the same center.

APPROACH: We asked patients and physicians to describe factors influencing mammography screening decisions of oldest-old women. We asked physicians to describe their counseling about screening to the oldest-old.

RESULTS: Patients and/or physicians identified the importance of physician influence, patient preferences, system factors, and social influences on screening decisions. Although physicians felt that patient's health affected screening decisions, few patients felt that health mattered. Three types of elderly patients were identified: (1) women enthusiastic about screening mammography; (2) women opposed to screening mammography; and (3) women without a preference who followed their physician's recommendation. However, physician counseling about mammography screening to elderly women varies; some individualize discussions; others encourage screening; few discourage screening. Physicians report that discussions about stopping screening can be uncomfortable and time consuming. Physicians suggest that more data could facilitate these discussions.

CONCLUSIONS: Some oldest-old women have strong opinions about screening mammography while others are influenced by physicians. Discussions about stopping screening are challenging for physicians. More data about the benefits and risks of mammography screening for women aged 80 or older could inform patients and improve provider counseling to lead to more rational use of mammography.

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