Use of the geriatric assessment in clinical practice in Mexico: A survey of cancer providers.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e24013-e24013
Author(s):  
Haydee Cristina Verduzco-Aguirre ◽  
Laura Margarita Bolano Guerra ◽  
Hector Martínez-Said ◽  
Gregorio Quintero Beulo ◽  
Eva Culakova ◽  
...  

e24013 Background: Despite the growing burden of cancer in older adults in Mexico, it is unknown how many cancer care providers in Mexico use information obtained through a geriatric assessment (GA) and/or geriatric oncology principles in their everyday clinical practice. Methods: We administered a cross-sectional survey to oncology providers in Mexico via the Mexican Society of Oncology mailing list (n = 1240). The survey included questions on demographics, awareness about geriatric oncology principles, and the use of the GA and other geriatric clinical tools. The primary outcome was to estimate the proportion of providers using GA tools through the question: “For your patients ≥65 years, do you perform a multidimensional geriatric assessment using validated tools?”. We hypothesized that ≤10% of respondents would give a positive answer. We used descriptive statistics and X2 tests to compare groups of respondents. Results: We obtained 196 answers (response rate 15.8%). 121 (62%) respondents were male; median age 42. 98 (50%) were surgical oncologists, 59 (30%) medical oncologists, and 38 (19%) radiation oncologists. Median time in practice was 8 years, with 39% practicing in Mexico City. A third had their practice at a public institution, 26% at a private institution, and 38% in both. The proportion of patients aged 65-79 and ≥80 seen on an average clinic day by the respondents was 30% and 10%, respectively. 121 (62%) reported having a geriatrician available at their practice site. 37 respondents (19%) reported using validated GA tools to evaluate older adults with cancer in their practice. The proportion of respondents who evaluated each GA domain is shown in Table 1. Male respondents (p=0.03), medical oncologists (p<0.01), and those with a less busy practice (≤10 patients/day) (p=0.01) were more likely to use validated tools to perform a GA. Regarding barriers for implementing GA, 37% reported lack of time, 49% lack of qualified personnel, 44% lack of knowledge of geriatric tools, 6% patient unwillingness to undergo a GA, and 8% prohibitive cost. Only 17 (9%) thought that information obtained through a GA would not lead to practice changes. Conclusions: According to our survey, the proportion of Mexican oncology providers using validated tools to perform a GA is 19%, which is higher than expected. Some GA domains, such as comorbidity and functional status, were commonly assessed, while others, such as fall history, were seldom evaluated. Common barriers for GA implementation were lack of qualified personnel and of knowledge about geriatric tools. We plan to further explore these barriers and potential facilitators through focused interviews in order to guide future interventions.[Table: see text]

2020 ◽  
pp. OP.20.00442
Author(s):  
William Dale ◽  
Grant R. Williams ◽  
Amy R. MacKenzie ◽  
Enrique Soto-Perez-de-Celis ◽  
Ronald J. Maggiore ◽  
...  

PURPOSE: For patients with cancer who are older than 65 years, the 2018 ASCO Guideline recommends geriatric assessment (GA) be performed. However, there are limited data on providers’ practices using GA. Therefore, ASCO’s Geriatric Oncology Task Force conducted a survey of providers to assess practice patterns and barriers to GA. METHODS: Cancer providers treating adult patients including those ≥ 65 years completed an online survey. Questions included those asking about awareness of ASCO’s Geriatric Oncology Guideline (2018), use of validated GA tools, and perceived barriers to using GA. Descriptive statistics and statistical comparisons between those aware of the Guideline and those who were not were conducted. Statistical significance was set at P < .05. RESULTS: Participants (N = 1,277) responded between April 5 and June 5, 2019. Approximately half (53%) reported awareness of the Guideline. The most frequently used GA tools, among those aware of the Guideline and those who were not, assessed functional status (69% v 50%; P < .001) and falls (62% v 45%; P < .001). Remaining tools were used < 50% of the time, including tools assessing weight loss, comorbidities, cognition, life expectancy, chemotherapy toxicity, mood, and noncancer mortality risk. GA use was two to four times higher among those who are aware of the Guideline. The most frequent barriers for those who reported being Guideline aware were lack of resources, specifically time (81.7%) and staff (77.0%). In comparison, those who were unaware of the Guideline most often reported the following barriers: lack of knowledge or training (78.4%), lack of awareness about tools (75.2%), and uncertainty about use of tools (75.0%). CONCLUSION: Among providers caring for older adults, 52% were aware of the ASCO Guideline. Some domains were assessed frequently (eg, function, falls), whereas other domains were assessed rarely (eg, mood, cognition). Guideline awareness was associated with two to four times increased use of GA and differing perceived barriers. Interventions facilitating Guideline-consistent implementation will require various strategies to change behavior.


2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S296-S296
Author(s):  
Chrysanne Karnick ◽  
Ruth Manna ◽  
Natalie Gangai ◽  
Rosario Costas Muniz ◽  
Beatriz Korc-Grodzicki

Abstract Older adults can reduce fall risk in their homes and the community. Health care professionals (HCP) have a role in preventing falls. An interprofessional team of HCPs at a comprehensive cancer center created and delivered educational workshops to increase knowledge about falls prevention. Educational workshops were provided in community centers, libraries, places of worship and at local hospitals to medically underserved, diverse community members, caregivers and HCP. An Occupational (OT) and Physical Therapist (PT) taught three workshops together and the OT taught nine workshops. Workshops included fall prevention, home modifications, safe patient handling (SPH), and the role of OT/ PT in geriatric oncology care. Practical and culturally competent steps were emphasized, with translation of written materials and live interpretation provided as appropriate. Knowledge increase was assessed, and post-session qualitative data was collected. The mean age of community members was 68 years, of nurses was 42, and of caregivers 63. A majority of participants were female. 220 older adults completed surveys, 40 caregivers, and 11 registered nurses. The Falls Prevention workshops with unmatched (n=79) and matched data (n=140) showed significant improvements in knowledge [t(135)=-3.33, p&lt;0.001; t(139)=-4.03, p&lt;.001; respectively). Caregivers who participated in the SPH workshop improved their learning for the unmatched (n=12) and matched data (n=28) after participating in the workshops [t(22)=-3.50, p=.002; t(27)=-3.95, p&lt;.001] respectively. For nurses, the change in scores from pre (M=.56) to post scores (M=.73) were significant (t=-2.76, df=10, p=.02). Caregivers and HCPs benefit from continued education to promote safer, holistic care for family members and patients.


2019 ◽  
Vol 10 (3) ◽  
pp. 51
Author(s):  
Jennifer M. Hackel ◽  
Teresa M. Eliot Roberts

This article reports on the effectiveness of a pilot project, where older adult volunteers attending college campus programs were recruited to act as mock patients (MP) in a two-hour clinical simulation experience for primary care nurse practitioner (NP) students learning about geriatric assessment. Primary care providers, such as NPs, study variable content on geriatrics and see older adults in their primary care clinical practica yet report they desire more time in their training to practice geriatric assessment techniques, apply clinical practice recommendations, and discuss broader aspects of cases being managed by NPs within the interdisciplinary team. Utilization of live models acting as MPs with small groups of students acting as one provider is one way in which health care trainees can take more time to learn from each other as well as the models in the simulated clinical setting. The professor wrote a hypothetical case study based on clinical practice experience that either a male or female volunteer retiree could play as the MP. The case was a 75-year-old retiree with multiple other chronic conditions, on multiple medications, presenting with acute on chronic fatigue. Of the 48 students who participated, 47 returned surveys. Aggregate scores indicated an overall effectiveness of 88% across multiple aspects of geriatric primary care. Qualitative data indicated that the NP students would like more such cases in which they get more lead time with the case information to consider the myriad factors at play and have smaller groups of students per MP. The older adults who volunteered as MPs reported overwhelmingly that they found participating in the students’ education to be rewarding and a chance to offer input about improvement in the care of older adults in the current health system in our aging society. There was consistent feedback that the program should be continued and enhanced. The case content is offered in this article for use by other health care professionals who educate trainees in primary care.


2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e24011-e24011
Author(s):  
Tomohiro F. Nishijima ◽  
Mototsugu Shimokawa ◽  
Taito Esaki ◽  
Masaru Morita ◽  
Yasushi Toh ◽  
...  

e24011 Background: A frailty index based on domain-level deficits in a comprehensive geriatric assessment (FI-CGA) has been previously developed and validated in general geriatric patients (Jones D, Aging Clin Exp Res 2005). Our objectives were to construct an FI-CGA and to assess its construct validity in geriatric oncology setting. Methods: Consecutive older adults with cancer who underwent a CGA on a geriatric oncology service were included. We developed a 10-item frailty index based on deficits in 10 domains (FI-CGA-10): cognition, mood, communication, mobility, balance, nutrition, basic and instrumental activities of daily living, social support and comorbidity. Deficits in each domain were scored as 0 (no problem), 0.5 (minor problem) and 1.0 (major problem). Scores were calculated by dividing the sum of the score of each domain by 10, and categorized as fit ( < 0.2), pre-frail (0.2–0.35), and frail ( > 0.35). Construct validity was tested by comparing the FI-CGA-10 with the following established frailty measures: the Canadian Study of Health and Aging (CSHA) Clinical Frailty Scale (CFS), CSHA rules-based frailty definition and CSHA Function Scale. To evaluate the ability to predict mortality, we tested association between the FI-CGA-10 and validated prognostic indices for mortality: the Lee index and Schonberg index (higher scores reflect a higher risk of mortality). We also examined associations between the FI-CGA-10 and several features commonly seen in frail older adults such as function (Timed Up & Go (TUG) test), cognitive impairment (Mini-Cog), and high comorbidity burden (Charlson Comorbidity Index (CCI)). Results: Of 540 patients (median age 80 years, range 66–96 years), common cancer types were gastrointestinal tract in 37%, hepatobiliary and pancreatic in 22%, and head and neck in 12%. 406 (75%) patients had ECOG PS 0 to 1. The FI-CGA-10 had a right-skewed distribution and was well approximated by the gamma distribution. Overall, 20% of patients were fit, 41% were pre-frail, and 39% were frail. The FI-CGA-10 was highly correlated with CSHA CFS (Pearson's r = 0.83), CSHA rules-based frailty definition (r = 0.67) and CSHA Function Score (r = 0.77). People who were more frail had higher scores on the Lee index (fit: 7.3, prefrail: 8.8, frail: 12.0; p < .0001) and Schonberg index (fit: 10.1, prefrail: 13.1, frail: 15.7; p < .0001), suggesting an increased probability of death. Increasing levels of frailty were significantly associated with a longer TUG (seconds), fit: 11.3, prefrail: 13.0, frail: 26.3; p < .0001, poorer cognitive function (Mini-Cog score, fit: 4.7, prefrail: 4.0, frail: 3.1; p < .0001), and higher comorbidity burden (CCI, fit: 0.8, prefrail: 1.4, frail: 1.9; p < .0001). Conclusions: The FI-CGA-10 is a clinically sensible and construct-validated measure of quantifying frailty from a CGA.


Cancers ◽  
2021 ◽  
Vol 13 (22) ◽  
pp. 5720
Author(s):  
Nienke A. de Glas

The incidence of cancer in older adults is strongly increasing due to the ageing of the population [...]


Cancers ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 3279
Author(s):  
Nienke A. de Glas

The number of older adults with cancer is strongly increasing due to the ageing of Western societies [...]


2015 ◽  
Vol 13 (9) ◽  
pp. 1120-1130 ◽  
Author(s):  
Supriya Gupta Mohile ◽  
Carla Velarde ◽  
Arti Hurria ◽  
Allison Magnuson ◽  
Lisa Lowenstein ◽  
...  

2018 ◽  
Vol 9 (6) ◽  
pp. 683-686 ◽  
Author(s):  
Daniel W. Yokom ◽  
Shabbir M.H. Alibhai ◽  
Schroder Sattar ◽  
Monika K. Krzyzanowska ◽  
Martine T.E. Puts

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