Introduction
Patients and methods
Study design
Study participants
Interviews
Survey and chart data
Data analysis
Results
Characteristic
|
Young old:
n = 21
|
Aged 80 years and older
n = 11
|
---|---|---|
Sex | ||
Woman | 5 (24 %) | 4 (36 %) |
Man | 16 (76 %) | 7 (64 %) |
Living alone | 5 (24 %) | 3 (27 %) |
Cancer type | ||
Breast | 3 (14 %) | 1 (9 %) |
Colorectal | 4 (19 %) | 1 (9 %) |
Prostate | 7 (33 %) | 4 (36 %) |
Lung | 7 (33 %) | 5 (45 %) |
Interview with family member | 16 (76 %) | 9 (82 %) |
Interview with oncologist | 18 (86 %) | 10 (91 %) |
Interview with family physician | 12 (57.1 %) | 6 (55 %) |
Themes according to participant group
Older adults
Relationship with the oncologist
Perceived benefits and harms/discomfort
Treatment experiences of important others/family influences
Family members
Trust in the oncologist
Perceived benefits and harms
Family physicians
Lack of involvement
Oncologists
“easy decision”
Comparison of the four perspectives
Domains
|
Older Adult
|
Family member
|
Cancer Specialist
|
Family physician
|
---|---|---|---|---|
Functional status
| Prolonging life is most important, for others maintaining quality of life is important | Prolonging life is most important | Most patients were fit, performance status is taken into account | Not involved |
Comorbidity
| Other health conditions do not play a role in the chemotherapy decision | Other health conditions do not play a role in the chemotherapy decision | Comorbidity is taken into account but most patients were fit so it did not play an important role | Not contacted for the patient’s medical history, some feel the patient’s comorbidity is underappreciated by oncologists |
Frailty
| Not mentioned by patients | Not mentioned by family members (but they do describe weakened states after the start of chemotherapy) | Not mentioned by all except one | Not contacted for any information with regard to health and functional status |
Different perspectives on frailty and function
Different perspectives on comorbidity
Differences in who made the decision
(Mis)communication
Suggestions for improvement
Patient
|
Family member
|
Oncologist
|
Family physician
|
---|---|---|---|
• More discussion about financial support in terms of travel costs during treatment. | • More written, understandable information about the recommended treatment | • More social work access | • Improvement on transportation and home care |
• Heads up if next appointment will involve decision-making so they can prepare and bring somebody; also, more time allocated for those appointments so that all questions can be asked | • More resources/directions on where to go online to find reliable information (e.g. provide a list of trustworthy websites). | • More support for patient assessment – no time in clinic to perform geriatric assessment (GA) | • More timely information about diagnosis, treatment (including actual drug and how it works), what side effects are and WHEN do they start |
• More clarification of medication terms | • More clarification with regard to medical terminology | • Get family physicians involved | • Opportunity to participate in discussion regarding end-of-life care |
• Listen to the patients | • Take time to sit down and listen to patients | • Each patient should be assigned a care navigator | • To be informed earlier if patients have no more treatment options; be informed by oncologist before hearing it from the patient |
• Nurses need to make more conversations | • More information on what treatment success means | • Be more informed about What treatment goal is | |
• Inform other patients that nurses are a source of support during TDMP | • Clinics should avoid appointment changes on short notice as it is very difficult for caregivers to arrange for time off work to come to appointments | • A paid patient navigator/manager (somebody with healthcare training such as a retired professional) should be assigned to each patient to help him/her navigate the system | |
• Each patient should be assigned a patient care coordinator/manager/navigator to help navigate the large, confusing system, which could be especially frightening for those who do not speak English. | • For patients with brain metastases, more consideration should be given in terms of who information is given to (if patient is confused) | • Oncologists need to understand psychosocial background and patient wishes | |
• More continuity in staff support (i.e. same nurse during each visit) | • Appointment reminders should be emailed to designated caregivers rather than to patients | • Oncologists should discuss more openly treatment goals – advanced care planning for patients | |
• Efforts should be made to ensure that phone numbers given to call for questions are helpful. Be sure there is someone to ask when questions arise | • Space and designated room in hospital for peer support (for patients and families). | ||
• Better communication and coordination to prevent contradicting treatment possibilities given to patients (fellows vs. oncologists) to avoid raising patients’ hopes only to be disappointed later when told something different. |