Jenna Smith, PhD
Medicine and Health
The University of Sydney
from September 2025 to January 2026
Born in 1995 in Nowra, NSW, Australia
BSc (Honours in Psychology) and PhD in Medicine and Health, The University of Sydney
Fellowship
College for Life Sciences
Project
Implementing Equitable Shared Decision Making for Older People in Primary Care
During my current fellowship at the Sydney Health Literacy Lab (The University of Sydney), I aim to implement shared decision making for older women in the national breast cancer screening program (i.e., through improved messaging and decision support tools). During my time at the Wissenschaftskolleg, I will be expanding this program of work to broadly think about how equitable shared decision making can be implemented in primary care health assessments for older people.All older people should have the opportunity to engage in primary care discussions about their health goals and the benefits and risks of interventions to make high-quality health decisions. Annual health assessments provide a chance for this, but shared decisions are difficult to achieve. I will develop interventions to enable older people to engage in discussions about their health in primary care.
I hope to broaden my horizons during my College for Life Sciences fellowship, particularly to explore the intersections of ageism, reducing overdiagnosis and overtreatment, health literacy, and equity, in the context of an increasingly digitalised health system. I will meet with academics, research groups, and clinicians to understand current efforts to implement shared decision making for older people in the German health system, as well as review the literature. This will enable me to form a comprehensive foundation of knowledge through reflection and discussions, gain creative insights I would otherwise miss out on, and ultimately strengthen my international impact in my first independent research program.
Recommended Reading
Smith, Jenna, Rachael H. Dodd, Karen M. Gainey, et al. (2021). “Patient-Reported Factors Associated with Older Adults’ Cancer Screening Decision-Making: A Systematic Review.” JAMA Network Open 4 (11): e2133406. https://doi.org/10.1001/jamanetworkopen.2021.33406.
Smith, Jenna, Erin Cvejic, Nehmat Houssami, et al. (2024). “Randomized Trial of Information for Older Women about Cessation of Breast Cancer Screening Invitations.” Journal of General Internal Medicine 39: 1332–1341. https://doi.org/10.1007/s11606-024-08656-3.
Smith, Jenna, Rachael H. Dodd, Katharine A. Wallis, et al. (2024). “General Practitioners’ Views and Experiences of Communicating with Older People about Cancer Screening: A Qualitative Study.” Family Practice 41 (4): 543–553. https://doi.org/10.1093/fampra/cmac126.
Colloquium, 26.11.2025
Ageism? Or preventing harms of overmedicalisation for older people?
Many countries have upper age limits for invitation or access to nationally funded cancer screening programs (e.g., 70 or 75 years). As such, some older people and advocacy groups cite cancer screening recommendations or guidelines as evidence of ageism in access to health care. Furthermore, national survey studies and monitoring reports highlight how adults aged 75 years and older continue to be screened for cancer internationally, including for breast cancer. This can, in part, be attributed to the symbolic importance of breast screening for older women, due to decades of messaging that has promoted increasing routine mammograms.
Using breast cancer screening as a case study, I will describe the unintended consequences of individual or collective anti-ageism efforts that simply promote increased access to preventive health interventions. I will highlight the risks of the intuitive “more is better” rhetoric in preventive health, for both older people’s individual health outcomes and our health system more broadly, and I will begin to situate this rhetoric within the modern paradigm of “successful aging.” Instead, I will argue for anti-ageist initiatives that focus on more evidence-based public health and primary care communication with older people that supports them to make informed choices that align with their goals and values. The multiple complexities in implementing this increasingly recommended “shared decision making” process in primary care for older people will also be examined.
