National authoritative groups (e.g., United States Preventive Services Task Force, American Cancer Society, etc.) recommend that physicians involve older adults in decisions about cancer screening and balance benefits against harms according to individual preferences, values, and health status rather than age. Cancer incidence increases with age. Because individual variations in health status also increase with age, the need to jointly involve the elderly and their physicians in tailoring decisions about cancer screening according to the individual patient also increases. However, older adults are less likely to use cancer screening and participate in screening decisions and little is known about how they make such decisions. The long-term objective of this project is to understand and ultimately enhance the decision-making processes of older adults. This will be accomplished through specific aims to (1) examine and describe decision-making processes employed by older women for breast, cervical, and colorectal cancer screening, including their decision-making preferences, actual involvement in cancer screening decisions, decisional conflict, and the influence of these on planning and obtaining breast, cervical, and colorectal screening; (2) examine the influence of individual characteristics (e.g., prior screening tests, demographics, health locus of control, orientation to medical care, social support, and health behaviors) as modifiers of decision-making processes. 1526 women aged equal to or > 60 years enrolled in the Stony Brook Women's Health Initiative (WHI) Clinical Center Observational Study (OS) will be recruited to participate. The proposed study will cost- effectively utilize the extensive WHI database about these women, which includes annual reports of screening for these cancers. Self-reported decision-making data will be obtained using mailed questionnaires and telephone follow-up. Health decisions consistent with patient preferences and values are supported by medical ethics and encouraged by the U.S. Preventive Services Task Force. Benefits of cancer screening are more dependent on individual characteristics than in younger adults. With the aging of the national population, informed strategies for enhancing decision-making among older adults are increasingly important for improving public health. ? ? ?
