What is the role of comorbidity, frailty, and functional status in the decision-making process for older adults with cancer and their family members, oncologists, and family physician?

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 92-92
Author(s):  
Martine Puts ◽  
Schroder Sattar ◽  
Kara McWatters ◽  
Katharine Lee ◽  
Michael Kulik ◽  
...  
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Functional Status ◽  
Family Physician ◽  
Family Members ◽  
Family Physicians ◽  
Treatment Decision ◽  
Decision Making Process ◽  
Theory Approach ◽  
Treatment Decision Making

92 Background: Little is known about the treatment decision making process (TDMP) in older adults (OA) with cancer. The objective of this study is to develop a theoretical framework with the aim to improve the TDMP for this population. Methods: This is a mixed methods multi-perspective longitudinal study. OAs aged > 70 years with advanced prostate, breast, colorectal, or lung cancer, their family members, oncologists and family physicians are invited to participate in individual, semi-structured interviews. Each OA also completes a short survey to characterize their health, functional status, frailty level, decision-making preferences, and satisfaction with the TDMP. The sample is stratified on age (70-79 and 80+) to obtain data saturation for the oldest old. All interviews will be analyzed using the grounded-theory approach. Results: To date, 32 first interviews and 15 second interviews have been completed with 32 older adults, 21 family members and 12 family physicians and 7 cancer specialists. Interviews lasted between 10-60 minutes. Most older adults felt that they should have the final say in the treatment decision, but strongly valued their physician’s opinion. Most participants felt they received enough information, time and support from the oncologist to make their decision. About half the participants went to see their family physician to talk about the diagnosis and plan. Comorbidity and potential side-effects did not play a major role in the decision-making processes for patients and families but it did for oncologists. Family physicians reported they were not involved in treatment decisions, and they preferred more timely information about the patient. Conclusions: This study-in-progress is examining the TDMP from four different perspectives and examining changes over time in the TDMP. Patients and family members were generally satisfied with the treatment decision making process. Final results will be presented at the conference.

Treatment decision-making for older adults with cancer: A qualitative study

2020 ◽  
pp. 096973302094575
Author(s):  
Ni Gong ◽  
Qianqian Du ◽  
Hongyu Lou ◽  
Yiheng Zhang ◽  
Hengying Fang ◽  
...  
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Cancer Patients ◽  
Family Members ◽  
Treatment Decision ◽  
Chinese Society ◽  
Decision Making Process ◽  
Treatment Decision Making ◽  
The Family ◽  
Older Cancer Patients

Background: Independent decision-making is one of the basic rights of patients. However, in clinical practice, most older cancer patients’ treatment decisions are made by family members. Objective: This study attempted to analyze the treatment decision-making process and formation mechanism for older cancer patients within the special cultural context of Chinese medical practice. Method: A qualitative study was conducted. With the sample saturation principle, data collected by in-depth interviews with 17 family members and 12 patients were subjected to thematic analysis. Ethical considerations: The study was approved by the ethics committees of Sun Yat-sen University. All participants provided verbal informed consent after being told their rights of confidentiality, anonymity, and voluntary participation. They had the right to refuse to answer questions and could withdraw at any time. Results: Three themes emerged: (1) complex process; (2) transformation of family decision-making power; and (3) individual compromise. Family members inevitably had different opinions during the long process of treatment decision-making for older cancer patients. The direction of this process could be regarded as an extension of the family power relationship. The patient usually compromised the decision to survive, which was made by family members. Conclusion: This study describes the treatment decision-making process of older cancer patients in the context of Chinese culture. The reasons underlying this process are related to the views on life and death and family values. An individual is a part of the family, which is often seen as the minimal interpersonal unit in Chinese society. It is significant that while emphasizing patient autonomy in the decision-making process, health professionals should also pay attention to the important roles of culture and family.

scholarly journals Lay Referral Patterns Involved in Cardiac Treatment Decision Making Among Middle-Aged and Older Adults

2003 ◽  
Vol 43 (4) ◽  
pp. 493-502 ◽  
Author(s):  
N. E. Schoenberg ◽  
C. H. Amey ◽  
E. P. Stoller ◽  
S. B. Muldoon
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Treatment Decision ◽  
Middle Aged ◽  
Referral Patterns ◽  
Treatment Decision Making

scholarly journals The deadly “bulging balloon” within the mediastinum: a case of a giant aortic root aneurysm in a young patient with Marfan syndrome

2020 ◽  
Author(s):  
JIAYU SHEN ◽  
Changping Gan ◽  
R.D.T. Rajaguru ◽  
Dou Yuan ◽  
ZHENGHUA XIAO
Keyword(s):  
Decision Making ◽  
Aortic Valve ◽  
Ct Scan ◽  
Young Patient ◽  
Marfan Syndrome ◽  
Aortic Root ◽  
Treatment Decision ◽  
Decision Making Process ◽  
Aortic Root Aneurysm ◽  
Treatment Decision Making

Abstract Introduction: Marfan syndrome (MFS) is a common heritable connective tissue disease involving multiple organs. Even though the clinical manifestations of MFS can be various, aortic root aneurysm is estimated as one of the most serious complications. We herein describe an individualized treatment decision-making process for a 23-year-old male with MFS, suffering from a giant but stable aortic root aneurysm which is extremely rare at his age. Case: The patient, a 23-year-old male with a family history of MFS, presented to our cardiovascular department because of progressive exertional chest distress, fatigue and occasional precordial pain. Physical examinations revealed six-foot-three inches of height, high myopia, and a diastolic murmur at the aortic valve area. Laboratory examinations for systemic vasculitis and infectious diseases were negative. The transthoracic echocardiography (TTE) and enhanced thoracic computed tomography (CT) scan revealed the existence of a giant aortic root aneurysm (125.1 mm in short-axis), severe aortic valve regurgitation, cardiac dilatation (LV; 99 mm in diastolic diameter) and a poor ejection fraction (EF; 18%). Considering the risk of rupture or dissection of the dilated aortic root, we successfully performed the Bentall procedure based on the intraoperative exploration results. Postoperative thoracic CT scan revealed a normal sized reconstructed aortic root, and the patient was discharged uneventfully 7 days later. Conclusion It is extremely rare to report such a giant aortic root aneurysm in a young patient. In the treatment decision-making process, the patient’s specific situation should be taken into consideration. The composite replacement of the aortic valve and ascending aorta should be performed if the patient is not suitable for valve-sparing operation.

Treatment decision-making preferences in older patients with metastatic colorectal cancer

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 8519-8519 ◽  
Author(s):  
E. B. Elkin ◽  
S. Lee ◽  
E. S. Casper ◽  
D. Kissane ◽  
N. E. Kemeny ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Decision Making ◽  
Metastatic Colorectal Cancer ◽  
Functional Status ◽  
Patient Preference ◽  
Older Patients ◽  
Treatment Decision ◽  
Demographic Characteristics ◽  
Treatment Decision Making ◽  
Decision Control

8519 Background: Shared decision-making is a tenet of contemporary oncology practice. However, it is uncertain how involved elderly patients want to be in making treatment decisions and how physicians perceive patient preferences for involvement in decision-making. Methods: In structured interviews about multiple facets of chemotherapy treatment decision-making, we asked patients age 70 and older seen at our specialty cancer center with a recent diagnosis of metastatic colorectal cancer (CRC) about their preferences for making treatment decisions. We used Degner’s control preference scale to measure patient preference for decision control. Treating oncologists described their perception of each patient’s preference for decision control using the same scale. Control preference was assessed in relation to socio-demographic characteristics and functional status. Results: Of 52 patients interviewed, the mean age was 76 years (range 70–89), 52% were male, 60% were educated beyond high school and 25% required some help with activities of daily living (ADL). Preferences for involvement in treatment decision-making demonstrated marked variation (Table). Compared with female patients, males expressed a stronger preference for decision control (p<0.05). Preference for decision control was somewhat greater in patients under age 80, those with more education, and those with no ADL impairment, but these associations were not statistically significant. In 26% of cases, the treating physician’s perception and the patient’s expressed preference for decision control were concordant. Conclusions: In older patients with advanced CRC, preference for control in treatment decision-making shows marked heterogeneity and some correlation with socio-demographic characteristics and functional status. Physicians’ perceptions of patient preference for decision control are often inconsistent with patients’ actual preferences. [Table: see text] No significant financial relationships to disclose.

Integrating a touchscreen-based brief geriatric assessment in older adults with multiple myeloma.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21703-e21703 ◽  
Author(s):  
Nitya Nathwani ◽  
Supriya Gupta Mohile ◽  
Brea Lipe ◽  
Karen Carig ◽  
Laura DiGiovanni ◽  
...  
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Multiple Myeloma ◽  
Geriatric Assessment ◽  
Daily Living ◽  
Dose Intensity ◽  
Treatment Decision ◽  
Activity Of Daily Living ◽  
Treatment Decision Making ◽  
Frailty Score

e21703 Background: Multiple myeloma (MM) is a disease of older adults (OAs) with > 60% of diagnoses and nearly 75% of deaths occurring in patients > 65 years old (YO). Geriatric Assessment (GA) is associated with toxicity and survival in OAs with MM, but not routinely used in practice. This project pilot tests a tablet-based modified Geriatric Assessment (mGA) that presents compiled GA results, including (the Palumbo) frailty score, to clinicians at a treatment decision-making visit in a single screen dashboard. Methods: In this multisite ongoing study, 210 patients with MM ≥65 YO facing a decision point for care will complete a mGA that includes the Charlson Comorbidity Index (CCI), Katz Activity of Daily Living (ADL) Score, and Lawton Instrumental Activity of Daily Living (IADL) Score prior to meeting with a physician. mGA results, including composite frailty score, are provided to physicians at the start of a visit. Results: Thirty-six patients have been enrolled to date; enrollment continues. Participants are 69% (n = 25) white, 64% (n = 23) male, and mean age of 72 YO (range 65-87). Most (74%, n = 20) currently receive ≥1 therapy and have few co-morbidities (CCI median 1, SD 1.95, range 0-8); 57% require assistance with IADLs and 37% require assistance with ADLs. Based on Palumbo score, 36% of participants were frail (n = 13), 33% intermediate (n = 12), and 31% fit (n = 11). Providers report mGA results influenced treatment decision (54%, n = 28) and frailty score was the most frequently cited result to impact treatment decision-making (61%, n = 39). The most common way the mCGA influenced decision-making was to reduce dose/dose intensity (25%, N = 8). Clinicians on average spent 5 minutesreviewing the mGA results. Patients reported an average of 7 minutes to complete the survey, most independently (83%, n = 30), and were satisfied with the electronic program overall (80%, n = 29), including how easy it was to use (88%, n = 32). Conclusions: Preliminary data support feasibility, usability, and acceptability of the tablet-based mGA and that frailty score influences provider decision-making ≥50% of the time. Future analyses will explore the relationship of the mGA with toxicity, dose modification and/or treatment discontinuation in OAs with MM.

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