Psychosocial and clinical predictors of continued cancer screening in older adults

•We describe factors influencing older adults’ cancer screening decisions.•Important factors are cancer anxiety, screening enthusiasm, routine adherence.•These factors undermine efforts to promote informed decision-making.•Clinicians may need to address cancer anxiety in screening discussions. Many older adults (aged 75+) continue cancer screening despite guidelines suggesting they should not. Using mixed-methods, we examined psychosocial and clinical factors associated with continued breast/prostate screening. We conducted an online, scenario-based, randomized study in Australia with participants aged 65+ years. The primary outcome was screening intention (10-point scale, dichotomized: low (1−5) and high (6−10)). We also measured demographic, psychosocial, and age-related clinical variables. Participants provided reason/s for their screening intentions in free-text. 271 eligible participants completed the survey (aged 65–90 years, 71% adequate health literacy). Those who reported higher cancer anxiety, were men, screened more recently, had family history of breast/prostate cancer and were independent in activities of daily living, were more likely to intend to continue screening. Commonly reported reasons for intending to continue screening were grouped into six themes: routine adherence, the value of knowing, positive screening attitudes, perceived susceptibility, benefits focus, and needing reassurance. Psychosocial factors may drive continued cancer screening in older adults and undermine efforts to promote informed decision-making. When communicating benefits and harms of cancer screening to older adults, both clinical and psychosocial factors should be discussed to support informed decision-making.