Patient’s views on the decision to investigate cancer symptoms in older adults: a qualitative interview study

Cancer is predominantly a disease of older adults. To date there has been little research on the experiences of older adults or their view on the diagnostic pathway. The aim was to gain an improved understanding of the views and experiences of older adults on all aspects of cancer investigation via a qualitative study using semi-structured interviews with patients aged 70 and over. Data were analysed using a thematic framework analysis. The themes identified in participant’s 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 (all White-British) 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. In conclusion, older 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 is important to patients, regardless of age.