Patients’ views on the decision to investigate cancer symptoms in older adults: a qualitative interview study in primary care

Abstract

BackgroundCancer is predominantly a disease of older adults. To date there has been little research on the experiences of older adults or their views on the diagnostic pathway.AimTo gain an improved understanding of the views and experiences of older adults on all aspects of cancer investigation.Design and settingThis was a qualitative study using semi-structured interviews with patients aged ≥70 years. Patients were recruited from primary care in West Yorkshire, UK.MethodData were analysed using a thematic framework analysis.ResultsThe themes identified in participants’ accounts included the patients’ process of decision making, the value of having a diagnosis, the patients’ experience of cancer investigations, and the impact of the COVID-19 pandemic on the diagnostic pathway. Older adults in this study indicated a clear preference for having clarity on the cause of symptoms and the diagnosis, even in the face of unpleasant investigations. Patients suggested they wanted to be involved in the decision process.ConclusionOlder adults who present to primary care with symptoms suggestive of cancer may accept diagnostic testing solely for the benefit of knowing the diagnosis. There was a clear patient preference that referrals and investigations for cancer symptoms should not be deferred or delayed based on age or subjective assessments of frailty. Shared decision making and being involved in the decision-making process are important to patients, regardless of age.