title: What is different about living alone with cancer in older age? A qualitative study of experiences and preferences for care.
abstract: BACKGROUND
  Increasing numbers of older patients with advanced cancer live alone but there is little research on how well health services meet their needs. The aim of this study was to compare the experiences and future preferences for care between two groups of older people with cancer in their last year of life; those who live alone, and those who live with co-resident carers.
  
  
  METHODS
  In-depth qualitative interviews were conducted with 32 people aged between 70 and 95 years who were living with cancer. They were recruited from general practices and hospice day care, when the responsible health professional answered no to the question, of whether they would be surprised if the patient died within twelve months. Twenty participants lived alone. Interviews were recorded and transcribed and the data analysed using a Framework approach, focussing on the differences and commonalities between the two groups.
  
  
  RESULTS
  Many experiences were common to all participants, but had broader consequences for people who lived alone. Five themes are presented from the data: a perception that it is a disadvantage to live alone as a patient, the importance of relational continuity with health professionals, informal appraisal of care, place of care and future plans. People who lived alone perceived emotional and practical barriers to accessing care, and many shared an anxiety that they would have to move into a care home. Participants were concerned with remaining life, and all who lived alone had made plans for death but not for dying. Uncertainty of timescales and a desire to wait until they knew that death was imminent were some of the reasons given for not planning for future care needs.
  
  
  CONCLUSIONS
  Older people who live alone with cancer have emotional and practical concerns that are overlooked by their professional carers. Discussion and planning for the future, along with continuity in primary care may hold the key to enhancing end-of-life care for this group of patients.
authors: Hull York Medical School, Department of Health Sciences, University of York, Seebholm Rowntree Building, Heslington, York YO10 5DD, UK. Barbara.hanratty@york.ac.uk
authors: Barbara
authors: B
authors: Hanratty
authors: Julia
authors: J
authors: Addington-Hall
authors: Antony
authors: A
authors: Arthur
authors: Lucy
authors: L
authors: Cooper
authors: Gunn
authors: G
authors: Grande
authors: Sheila
authors: S
authors: Payne
authors: Jane
authors: J
authors: Seymour
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers; D003266:Continuity of Patient Care / Q000592:standards; D005260:Female; D006801:Humans; D008132:Loneliness; D008297:Male; D009369:Neoplasms / Q000523:psychology*; D057240:Patient Preference / Q000523:psychology*; D036301:Qualitative Research; D011788:Quality of Life; D012111:Residence Characteristics; D012934:Social Isolation; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000523:psychology*; D013997:Time Factors