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

被引：45

作者：

Breslau, Erica S. ^{[1
]}

Gorin, Sherri Sheinfeld ^{[2
,3
]}

Edwards, Heather M. ^{[4
]}

Schonberg, Mara A. ^{[5
]}

Saiontz, Nicole ^{[6
]}

Walter, Louise C. ^{[7
,8
]}

机构：

[1] NCI, Healthcare Delivery Res Program, Div Canc Control & Populat Sci, 9609 Med Ctr Dr, Rockville, MD 20850 USA

[2] Leidos Biomed Res Inc, Frederick Natl Lab Canc Res, Frederick, MD USA

[3] Herbert Irving Comprehens Canc Ctr, New York Phys Canc, New York, NY USA

[4] Patient Ctr Outcomes Res Inst, Washington, DC USA

[5] Harvard Univ, Beth Israel Deaconess Med Ctr, Sch Med, Dept Med,Div Gen Med & Primary Care, Boston, MA 02215 USA

[6] NCI, Off Director, Div Canc Control & Populat Sci, Rockville, MD 20850 USA

[7] Univ Calif San Francisco, Dept Med, Div Geriatr, San Francisco, CA USA

[8] San Francisco VA Med Ctr, San Francisco, CA USA

来源：

JOURNAL OF GENERAL INTERNAL MEDICINE | 2016年 / 31卷 / 05期

基金：

美国国家卫生研究院;

关键词：

Individualized screening; Shared decisionmaking; Geriatric; Multilevel; Framework; WOMEN AGED 80; PREVENTIVE SERVICES; COLORECTAL-CANCER; BREAST-CANCER; LIFE EXPECTANCY; CHRONIC ILLNESS; HEALTH-CARE; MAMMOGRAPHY; UPDATE; INTERVENTIONS;

D O I：

10.1007/s11606-016-3629-y

中图分类号：

R19 [保健组织与事业（卫生事业管理）];

学科分类号：

摘要：

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.

引用

页码：539 / 547

页数：9

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