Intentions for Cancer Screening in Older Adults

The intervention will be delivered online and will take approximately 20-30 minutes to complete. Time 1 intervention: Hypothetical scenarios will be used to communicate the benefits and harms of cancer screening and to test different communication strategies on outcome measures. The text scenarios will be presented online using Qualtrics survey software. Intervention materials: A hypothetical scenario of a doctor’s visit- Participants will be asked to imagine that their doctor is speaking to them about cancer screening, providing them with the benefits and harms and telling them of the importance of making an informed decision. Participants will be randomised to receive one of four hypothetical scenarios, where the final statement the GP makes will be varied: 1) Benefits vs. harms: "This test may harm you more than benefit you." 2) Benefits vs. harms + negative framing life expectancy: "You may not live long enough to benefit from breast screening/PSA testing, and this test may harm you more than benefit you." 3) Benefits vs. harms + positive framing life expectancy: "Breast screening/PSA testing may not help you to live longer, and this test may harm you more than benefit you." 4) Benefits vs. harms + health status: "This test may harm you more than benefit you, so other aspects of your health should take priority." Time 2 Intervention: Second hypothetical scenario will highlight the counterintuitive nature of stopping screening. After completing the outcome measures after viewing the first hypothetical scenario, all participants will be presented with another scenario. They will be asked to imagine their GP continues discussing with them the idea of stopping screening. The GP will acknowledge the counterintuitive nature of stopping screening by providing an anchoring frame, where a reason for why the change in recommendation has occurred. The second hypothetical scenario will read: "For many years breast/prostate cancer screening has been strongly recommended, but we now know more about the harms and benefits than we did when these cancer screening programs began. A large body of research has shown that for older people like you the harms might outweigh the benefits such as those that we discussed earlier. So, this is why I don't think you should get the test anymore."