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A systematic review of factors influencing older adults' decision to accept or decline cancer treatment in studies examining actual treatment decisions
Abstracts
Puts, M.T.E., Papoutsis, A., Springall, E., & Tourangeau, A.E. (2012). A systematic review of unmet needs of newly diagnosed older cancer patients undergoing active cancer treatment. Supportive Care in Cancer, 20(7), 1377–1394. Disclosure of interest: None declared. Keywords: Nursing, Policies doi:10.1016/j.jgo.2014.09.124
Supportive care in elderly cancer patients P096 PROFESSIONAL’S EXPECTATIONS TO IMPROVE QUALITY OF CARE, SUPPORTIVE HEALTH CARE AND SOCIAL SERVICES UTILIZATION IN GERIATRIC ONCOLOGY V. Antoine1,⁎, B. de Wazières2, N. Houédé3 1 Consultation d'oncogériatrie, CHRU Nîmes, Nîmes, France 2 Médecine Gériatrique, CHRU Nîmes, Nîmes, France 3 Oncologie médicale, CHRU Nîmes, Nîmes, France Introduction: Coordination of a multidisciplinary and multiprofessional intervention is a key issue in the management of elderly cancer patients to improve health status and quality of life. Optimizing the links between professionals is needed to improve care planning, health and social service utilization. Objectives: Optimize the links between professionals and improve care planning, health and social service utilization. Methods: Descriptive study in a French University Hospital. A 6 item structured questionnaire was addressed to professionals involved in global and supportive cares of elderly cancer patients (name, location, effective’s health care and services offered, needs to improve the quality of their intervention). After the analysis of answers, definition of propositions to improve cares and services utilization. Results: The 37 respondents identified a total of 166 needs to improve quality care in geriatric oncology. Major expectations were concerning improvement of global/supportive cares and health care services utilization, a better coordination between geriatric teams and oncologists. Ten propositions, including a model of in-hospital health-care planning were defined to answer to professional’s needs with the aim of optimizing cancer treatment and global cares. Conclusion: Identification of effective services and needs can represent a first step in a continuous program to improve quality of cares, according to the French national cancer plan 2014–2019. It allows federating professionals for a coordination effort, a better organization of the clinical activity in geriatric oncology, to optimize clinical practice and global cares. Disclosure of interest: None declared. Keyword: Communication doi:10.1016/j.jgo.2014.09.125
Supportive care in elderly cancer patients P097 A SYSTEMATIC REVIEW OF FACTORS INFLUENCING OLDER ADULTS' DECISION TO ACCEPT OR DECLINE CANCER TREATMENT IN STUDIES EXAMINING ACTUAL TREATMENT DECISIONS M. Puts1,⁎ , B. Tapscott1, M. Fitch2, D. Howell3, J. Monette4, D. Wan-Chow-Wah4, M. Krzyzanowska5, N. Leighl5, E. Springall6,
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S. Alibhaig 1 Nursing, University of Toronto, Canada 2 Odette Cancer Centre, Sunnybrook Health Sciences Centre, Canada 3 Oncology Nursing, Princess Margaret Cancer Centre University Health Network, Toronto, Canada 4 Geriatric Medicine, Jewish General Hospital, Montreal, Canada 5 Medical Oncology, Princess Margaret Cancer Centre University Health Network, Canada 6 Gerstein Science Information Centre, University of Toronto, Canada g Medicine, University Health Network, Toronto, Canada Introduction: Cancer is mostly a disease that affects older adults. Older adults often have other chronic health conditions in addition to cancer, which impacts cancer treatment decision-making. Up until now no systematic review of factors that influence older cancer patient’s decision to accept or decline cancer treatment had been conducted. Objectives: 1) To conduct a systematic review with the primary objective of to synthesize all studies to identify factors influencing older adults' decision to accept or decline cancer treatment proposed by their physician across studies. In particular, we were interested if the factors influencing older adults’ decision to accept or decline cancer treatment varied by cancer stage, type, cancer treatment, by age (younger old (65–75) and older old (75+))? Methods: Systematic review of the literature published between inception of the databases and February 2013. Dutch, English, French or German articles reporting on qualitative studies, cross-sectional, longitudinal observational or intervention studies reporting on factors why older adults accepted or declined cancer treatment examining actual treatment decisions were included. Data sources included MEDLINE, EMBASE, PsychInfo, CINAHL, Web of Science, ASSIA, AMED, Ageline, SocAbstracts and the Cochrane library. Two independent reviewers reviewed abstracts and completed the data abstraction using standardized forms. The quality of the included studies was assessed with the Mixed Methods Appraisal Tool 2011. Results: Of 17,343 abstracts reviewed, a total of 38 studies were included. The majority focused on breast and prostate cancer treatment decisions and many studies used a qualitative study design. The quality of the included studies varied from poor to excellent. Only two studies focused explicitly on reasons why older adults declined treatment. The most important factors for accepting treatment were trust in the physician and following the physician’s recommendation. Factors important for declining cancer treatment included perceived feeling of discomfort of the treatments, fear of side effects and transportation difficulties. There were few differences based on age and treatment; for the oldest old comfort during treatment was more important and younger old reported more pressure from their physicians to accept treatment. Similarly, reasons of comfort and convenience and benefits played a role when deciding between cancer treatment options and this was mostly studied in men with prostate cancer. No study examined differences by cancer type. Only one study examined differences by cancer stage. Conclusion: The reasons why older adults with cancer accepted or declined treatment varied considerably. Further studies using large representative samples and exploring treatment decision making incorporating health literacy and comorbidity are needed. Disclosure of interest: None declared. Keywords: Communication, Epidemiology, Nursing doi:10.1016/j.jgo.2014.09.126
Puts, M.T.E., Papoutsis, A., Springall, E., & Tourangeau, A.E. (2012). A systematic review of unmet needs of newly diagnosed older cancer patients undergoing active cancer treatment. Supportive Care in Cancer, 20(7), 1377–1394. Disclosure of interest: None declared. Keywords: Nursing, Policies doi:10.1016/j.jgo.2014.09.124
Supportive care in elderly cancer patients P096 PROFESSIONAL’S EXPECTATIONS TO IMPROVE QUALITY OF CARE, SUPPORTIVE HEALTH CARE AND SOCIAL SERVICES UTILIZATION IN GERIATRIC ONCOLOGY V. Antoine1,⁎, B. de Wazières2, N. Houédé3 1 Consultation d'oncogériatrie, CHRU Nîmes, Nîmes, France 2 Médecine Gériatrique, CHRU Nîmes, Nîmes, France 3 Oncologie médicale, CHRU Nîmes, Nîmes, France Introduction: Coordination of a multidisciplinary and multiprofessional intervention is a key issue in the management of elderly cancer patients to improve health status and quality of life. Optimizing the links between professionals is needed to improve care planning, health and social service utilization. Objectives: Optimize the links between professionals and improve care planning, health and social service utilization. Methods: Descriptive study in a French University Hospital. A 6 item structured questionnaire was addressed to professionals involved in global and supportive cares of elderly cancer patients (name, location, effective’s health care and services offered, needs to improve the quality of their intervention). After the analysis of answers, definition of propositions to improve cares and services utilization. Results: The 37 respondents identified a total of 166 needs to improve quality care in geriatric oncology. Major expectations were concerning improvement of global/supportive cares and health care services utilization, a better coordination between geriatric teams and oncologists. Ten propositions, including a model of in-hospital health-care planning were defined to answer to professional’s needs with the aim of optimizing cancer treatment and global cares. Conclusion: Identification of effective services and needs can represent a first step in a continuous program to improve quality of cares, according to the French national cancer plan 2014–2019. It allows federating professionals for a coordination effort, a better organization of the clinical activity in geriatric oncology, to optimize clinical practice and global cares. Disclosure of interest: None declared. Keyword: Communication doi:10.1016/j.jgo.2014.09.125
Supportive care in elderly cancer patients P097 A SYSTEMATIC REVIEW OF FACTORS INFLUENCING OLDER ADULTS' DECISION TO ACCEPT OR DECLINE CANCER TREATMENT IN STUDIES EXAMINING ACTUAL TREATMENT DECISIONS M. Puts1,⁎ , B. Tapscott1, M. Fitch2, D. Howell3, J. Monette4, D. Wan-Chow-Wah4, M. Krzyzanowska5, N. Leighl5, E. Springall6,
S69
S. Alibhaig 1 Nursing, University of Toronto, Canada 2 Odette Cancer Centre, Sunnybrook Health Sciences Centre, Canada 3 Oncology Nursing, Princess Margaret Cancer Centre University Health Network, Toronto, Canada 4 Geriatric Medicine, Jewish General Hospital, Montreal, Canada 5 Medical Oncology, Princess Margaret Cancer Centre University Health Network, Canada 6 Gerstein Science Information Centre, University of Toronto, Canada g Medicine, University Health Network, Toronto, Canada Introduction: Cancer is mostly a disease that affects older adults. Older adults often have other chronic health conditions in addition to cancer, which impacts cancer treatment decision-making. Up until now no systematic review of factors that influence older cancer patient’s decision to accept or decline cancer treatment had been conducted. Objectives: 1) To conduct a systematic review with the primary objective of to synthesize all studies to identify factors influencing older adults' decision to accept or decline cancer treatment proposed by their physician across studies. In particular, we were interested if the factors influencing older adults’ decision to accept or decline cancer treatment varied by cancer stage, type, cancer treatment, by age (younger old (65–75) and older old (75+))? Methods: Systematic review of the literature published between inception of the databases and February 2013. Dutch, English, French or German articles reporting on qualitative studies, cross-sectional, longitudinal observational or intervention studies reporting on factors why older adults accepted or declined cancer treatment examining actual treatment decisions were included. Data sources included MEDLINE, EMBASE, PsychInfo, CINAHL, Web of Science, ASSIA, AMED, Ageline, SocAbstracts and the Cochrane library. Two independent reviewers reviewed abstracts and completed the data abstraction using standardized forms. The quality of the included studies was assessed with the Mixed Methods Appraisal Tool 2011. Results: Of 17,343 abstracts reviewed, a total of 38 studies were included. The majority focused on breast and prostate cancer treatment decisions and many studies used a qualitative study design. The quality of the included studies varied from poor to excellent. Only two studies focused explicitly on reasons why older adults declined treatment. The most important factors for accepting treatment were trust in the physician and following the physician’s recommendation. Factors important for declining cancer treatment included perceived feeling of discomfort of the treatments, fear of side effects and transportation difficulties. There were few differences based on age and treatment; for the oldest old comfort during treatment was more important and younger old reported more pressure from their physicians to accept treatment. Similarly, reasons of comfort and convenience and benefits played a role when deciding between cancer treatment options and this was mostly studied in men with prostate cancer. No study examined differences by cancer type. Only one study examined differences by cancer stage. Conclusion: The reasons why older adults with cancer accepted or declined treatment varied considerably. Further studies using large representative samples and exploring treatment decision making incorporating health literacy and comorbidity are needed. Disclosure of interest: None declared. Keywords: Communication, Epidemiology, Nursing doi:10.1016/j.jgo.2014.09.126