Patient Advocacy and Cancer Screening in Late Life

Objective: We explored the influence of patients’ proactivity in communication, their age, and co-morbidities on physician recommendations of breast and colorectal cancer screening. We focused on mammogram and colonoscopy/sigmoidoscopy, as the recommended screening tests for these prevalent late life cancers. Methods: Data are based on interviews with 414 independent community dwelling elderly participants in a long-term panel study (Mean age 81.2; SD 7.6). Results: Patient age was found to be the strongest deterrent to physician recommendation for each of the two cancer screening tests. Patient advocacy in requesting referrals resulted in higher rates of screening recommendations for both tests considered. Multivariate analyses indicated that, contrary to practice guidelines, patients with more chronic illnesses were more likely to receive screening recommendations for both cancers. On the other hand, being free of functional limitations increased screening recommendations for cancers considered. We found significant concordance between physician recommendation and patient screening adherence. Conclusion: Elderly patient initiative and assertiveness in communication with physicians can play a significant role in eliciting cancer screening recommendations. Such consumer proactivity and advocacy can counteract current practices of using age, rather than life limiting illness, as the criterion for curtailing cancer screening of elderly patients. Practice Implications: Improved self-advocacy by older patients is likely to contribute to better preventive health care.