Chemotherapy treatment decision-making experiences of older adults with cancer, their family members, oncologists and family physicians: a mixed methods study

Abstract

PurposeAlthough comorbidities, frailty, and functional impairment are common in older adults (OA) with cancer, little is known about how these factors are considered during the treatment decision-making process by OAs, their families, and health care providers. Our aim was to better understand the treatment decision process from all these perspectives.MethodsA mixed methods multi-perspective longitudinal study using semi-structured interviews and surveys with 29 OAs aged ≥70 years with advanced prostate, breast, colorectal, or lung cancer, 24 of their family members,13 oncologists, and 15 family physicians was conducted. The sample was stratified on age (70–79 and 80+). All interviews were analyzed using thematic analysis.ResultsThere was no difference in the treatment decision-making experience based on age. Most OAs felt that they should have the final say in the treatment decision, but strongly valued their oncologists’ opinion. “Trust in my oncologist” and “chemotherapy as the last resort to prolong life” were the most important reasons to accept treatment. Families indicated a need to improve communication between them, the patient and the specialist, particularly around goals of treatment. Comorbidity and potential side-effects did not play a major role in the treatment decision-making for patients, families, or oncologists. Family physicians reported no involvement in decisions but desired to be more involved.ConclusionThis first study using multiple perspectives showed neither frailty nor comorbidity played a role in the treatment decision-making process. Efforts to improve communication were identified as an opportunity that may enhance quality of care.Condensed abstractIn a mixed methods study multiple perspective study with older adults with cancer, their family members, their oncologist and their family physician we explored the treatment decision making process and found that most older adults were satisfied with their decision. Comorbidity, functional status and frailty did not impact the older adult’s or their family members’ decision.Electronic supplementary materialThe online version of this article (doi:10.1007/s00520-016-3476-8) contains supplementary material, which is available to authorized users.

Healthcare providers’ perspectives on care coordination for adults with cancer and multiple chronic conditions: a systematic review

“…Most studies reported in the 22 articles had a cross‐sectional quantitative (13) or qualitative (6) design, while two used mixed methods (surveys and interviews), and one was longitudinal (surveys and interviews) . Most (19) included physician perspectives as a main outcome measure, although three included physician perspectives as an adjunct to patient perspectives. Some articles were excluded because they focused on nonphysician providers such as nurses, nurse practitioners, physician assistants and allied healthcare providers.…”

“…Two studies in this review focused on patients with lung cancer, two focused on breast cancer, and the remaining 18 focused on multiple or unspecified types of cancer . Also, studies focused on different phases of cancer care, including those who had completed cancer treatment, were undergoing active cancer treatment or were in varying or unspecified phases of cancer care.…”

“…Table describes the risk of bias in individual studies. MMAT quality scores ranged from 2 to 5, with four studies assigned a score of 2 or 3 (moderate risk of bias) and 18 studies assigned a score of 4 or 5 (low risk of bias). Quality scores are based on information presented in an article, how well this information matched quality criteria described in the MMAT and evaluators’ judgement; thus, scores may have a subjective component and may not reflect the actual quality of the study in question.…”

“…Many studies indicated the importance of PCPs to provide emotional, psychosocial and psychological support, but some oncologists and PCPs had differing opinions about PCPs’ ability to adequately deliver psychosocial support . Further, an interference between MCC care and cancer care was noted, with MCC care being deprioritized during active cancer therapy, yet oncologists reporting that MCC minimally affected treatment decisions for cancer survivors …”

“…Most retained studies did not explicitly differentiate providers’ communication patterns in caring for cancer patients with MCC versus without MCC or explicitly differentiate providers’ communication patterns in caring for MCC that are potentially related versus unrelated to cancer and its treatment. However, results highlighted a need for improved communication between PCPs and oncologists who were managing cancer care for mutual patients . PCPs stated that they had difficulty reaching oncology specialists to clarify cancer treatment follow‐up plans or request additional information about patients’ treatment history .…”