2013 Winter Medical Editor's Meeting: Kathleen Fairfield, MD, MPH, DrPH

1. DECISIONS ABOUT MEDICATION USE
AND CANCER SCREENING AMONG
ELDERLY ADULTS IN THE UNITED
STATES
Fairfield KM, Gerstein B, Levin CA, McNaughton-
Collins M

2. BACKGROUND
¢ Elderly adults frequently encounter medical
decisions, yet little is known about the process
and quality of these decisions.
¢ Improved decision making about medication use
and cancer screening may have relevance in
preventing harm from:
— over-screening
— over-treatment
— polypharmacy

3. TRENDS STUDY DESIGN
¢ The TRENDS study is a survey of adults aged 40 and
over in the US conducted in 2011 via an Internet
panel.
¢ A decision for the purposes of this study includes
whether the respondent had or discussed having a
cancer screening test (breast, prostate, or colorectal
cancer) or whether the respondent started or stopped,
or discussed starting or stopping a medication for
hypertension, cholesterol, or depression within the
past two years.
¢ Respondents who made either one or two of the
targeted medical decisions were asked a series of
questions about each decision. Respondents who
made three or more of the targeted medical decisions
were asked about the two that are the least common
based on U.S. prevalence rates.

4. DECISION PROCESS AND VALUE SCORES
¢ Respondents were queried about:
— decision process (such as whether pros and cons were
addressed, whether their opinion was sought, and
who made the final decision)
— knowledge about the treatment, decisional regret,
and perceived benefit and costs (including side
effects, out of pocket costs, having to take medication,
false alarms, and having to deal with a cancer that
might not cause any harm)

5. ANALYSES
¢ Age was the primary variable of interest
— <60, 60-74, 75+
— Decided on 75+ as the elderly group because of
screening guidelines and face validity for competing
risks discussion
— Sample size tradeoff for 75+ group
¢ Results presented only for respondents who were
screened/ took medications
¢ ANOVA to analyze data as appropriate
¢ Mainly descriptive statistics

6. RESULTS
¢ # of respondents ranged from 271-894 across 5
topics
— 40-60% across topics were aged <60
— 32-51% across topics were aged 60-74
— 8-16% across topics were aged 75+
¢ Decision process scores were similar (and
generally low) across age groups for medication
and cancer screening
— indicates that all groups had poor involvement in
medical decision making
— The most aged (75+) respondents with 1+ risk factor
for heart disease had significantly lower decision
process scores (p=0.02)

7. RESULTS
¢ Knowledge about medications was higher than
for screening tests, yet did not vary significantly
by age.
¢ All age groups tended to place positive value on
potential benefits of screening and medication
¢ All age groups averaged 8+ (scale 0-10) on importance of
potential screening benefits (e.g., finding cancer early)
¢ All age groups averaged 9+ (scale 0-10) on importance of
potential medication benefits (e.g., lowering risk of heart
attack)

8. RESULTS
¢ The most aged (75+) respondents reported:
¢ For CRC screening:
¢ Less discomfort with handling stool
¢ Less concern about annual testing
¢ For Breast cancer screening
¢ Greater importance of peace of mind (after normal)
¢ For Medications:
¢ Less importance of minimizing out of pocket costs
¢ Less importance of avoiding taking cholesterol meds
¢ Surprisingly little concern about avoiding side effects

9. CONCLUSIONS
¢ Elderly respondents to this national survey report
weak decision processes when facing choices about
common medications and cancer screening
¢ This is despite:
— little evidence of benefit for some interventions (cancer
screening, cholesterol lowering medicines in low risk
elderly)
— possibility of harm (overdiagnosis, overtreatment, and
polypharmacy in elders)
¢ Opportunity to educate elders and medical
professionals who care for them when considering
cancer screening and adding medications:
¢ estimated benefits
¢ competing risks

10. DISCUSSION
¢ Questions about findings to date?
¢ Additional analyses this group can suggest?
¢ Emphasis area for manuscript?