Lisa M Lowenstein1, Robert J Volk2, Richard Street3, Marie Flannery4, Allison Magnuson5, Ronald Epstein6, Supriya G Mohile5. 1. Department of Medicine, Hematology/Oncology, Wilmot Cancer Center, University of Rochester. 601 Elmwood Avenue, Box, 704, Rochester, NY, USA. Electronic address: lmlowenstein@mdanderson.org. 2. Department of Health Services Research, The University of Texas MD Anderson Cancer Center. 1400 Pressler St., Unit 1444, Houston, TX, 77030, USA. 3. Department of Communication, Texas A&M University. College Station, TX, 77843, USA. 4. School of Nursing, University of Rochester. 255 Crittenden Blvd. Box SON, Rochester, NY 14642, USA. 5. Department of Medicine, Hematology/Oncology, Wilmot Cancer Center, University of Rochester. 601 Elmwood Avenue, Box, 704, Rochester, NY, USA. 6. Department of Family Medicine, University of Rochester. 1381 South Avenue, Rochester, NY 14620, USA.
Abstract
OBJECTIVES: Older patients with advanced cancer often have age-related health issues (e.g., memory impairment) that influence their cancer treatment decisions. Communication about these age-related concerns can potentially lead to further assessment and subsequent clinical interventions to improve treatment decision-making and patients' quality of life. Yet, little is known about the communication of age-related concerns between oncologists, patients, and caregivers. MATERIALS AND METHODS: This study is a secondary analysis of data from the Values and Options in Cancer Care (VOICE) study. Audio-recorded and transcribed outpatient clinical oncology encounters with 37 patients with advanced cancer ≥60 years of age were content-analyzed. Two trained coders used a structured coding scheme based on pre-specified geriatric assessment (GA) domains to examine the transcripts for the frequency and quality of communication about age-related concerns. Atlas.ti version 6 was used for all analyses. RESULTS: The median age of the patients was 66 years (range = 60-90 years); patients were mostly female (26/37), married (22/37), and White (36/37). Out of 37 audio-recorded visits, 31 had at least one mention of an age-related concern with a total of 70 mentions. Oncologists initiated communication about age-related concerns half of the time (53%). When age-related concerns were mentioned, half of the time (50%) the oncologist did not implement further evidence-based interventions to address the age-related concern (e.g., conduct a cognitive screen for a memory concern). CONCLUSION: Interventions are needed to improve the frequency and quality of the communication about age-related concerns to improve the care of older adults with cancer.
OBJECTIVES: Older patients with advanced cancer often have age-related health issues (e.g., memory impairment) that influence their cancer treatment decisions. Communication about these age-related concerns can potentially lead to further assessment and subsequent clinical interventions to improve treatment decision-making and patients' quality of life. Yet, little is known about the communication of age-related concerns between oncologists, patients, and caregivers. MATERIALS AND METHODS: This study is a secondary analysis of data from the Values and Options in Cancer Care (VOICE) study. Audio-recorded and transcribed outpatient clinical oncology encounters with 37 patients with advanced cancer ≥60 years of age were content-analyzed. Two trained coders used a structured coding scheme based on pre-specified geriatric assessment (GA) domains to examine the transcripts for the frequency and quality of communication about age-related concerns. Atlas.ti version 6 was used for all analyses. RESULTS: The median age of the patients was 66 years (range = 60-90 years); patients were mostly female (26/37), married (22/37), and White (36/37). Out of 37 audio-recorded visits, 31 had at least one mention of an age-related concern with a total of 70 mentions. Oncologists initiated communication about age-related concerns half of the time (53%). When age-related concerns were mentioned, half of the time (50%) the oncologist did not implement further evidence-based interventions to address the age-related concern (e.g., conduct a cognitive screen for a memory concern). CONCLUSION: Interventions are needed to improve the frequency and quality of the communication about age-related concerns to improve the care of older adults with cancer.
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