title: A systematic review of factors influencing older adults' decision to accept or decline cancer treatment.
abstract: BACKGROUND
  Cancer is a disease that affects mostly older adults. Older adults often have other chronic health conditions in addition to cancer and may have different health priorities, both of which can impact cancer treatment decision-making. However, no systematic review of factors that influence an older cancer patient's decision to accept or decline cancer treatment has been conducted.
  
  
  METHODS
  Systematic review of the literature published between inception of the databases and February 2013. Dutch, English, French or German articles reporting on qualitative studies, cross-sectional, longitudinal observational or intervention studies describing factors why older adults accepted or declined cancer treatment examining actual treatment decisions were included. Ten databases were used. Two independent reviewers reviewed manuscripts and performed data abstraction using a standardized form and the quality of studies was assessed with the Mixed Methods Appraisal Tool.
  
  
  RESULTS
  Of 17,343 abstracts reviewed, a total of 38 studies were included. The majority focused on breast and prostate cancer treatment decisions and most studies used a qualitative design. Important factors for accepting treatment were convenience and success rate of treatment, seeing necessity of treatment, trust in the physician and following the physician's recommendation. Factors important for declining cancer treatment included concerns about the discomfort of the treatments, fear of side effects and transportation difficulties.
  
  
  CONCLUSIONS
  Although the reasons why older adults with cancer accepted or declined treatment varied considerably, the most consistent determinant was physician recommendation. Further studies using large, representative samples and exploring decision-making incorporating health literacy and comorbidity are needed.
authors.affiliation: Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada. Electronic address: martine.puts@utoronto.ca.
authors.forename: Martine T E
authors.initials: MT
authors.lastname: Puts
authors.affiliation: Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
authors.forename: Brianne
authors.initials: B
authors.lastname: Tapscott
authors.affiliation: Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
authors.forename: Margaret
authors.initials: M
authors.lastname: Fitch
authors.affiliation: Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada; Department of Oncology Nursing, Princess Margaret Cancer Centre, Toronto, Canada.
authors.forename: Doris
authors.initials: D
authors.lastname: Howell
authors.affiliation: Division of Geriatric Medicine, and McGill University/Université de Montreal Solidage Research Group on Frailty and Aging, Jewish General Hospital, Montreal, Canada.
authors.forename: Johanne
authors.initials: J
authors.lastname: Monette
authors.affiliation: Division of Geriatric Medicine, and McGill University/Université de Montreal Solidage Research Group on Frailty and Aging, Jewish General Hospital, Montreal, Canada.
authors.forename: Doreen
authors.initials: D
authors.lastname: Wan-Chow-Wah
authors.affiliation: Department of Medical Oncology, Princess Margaret Cancer Centre, Toronto, Canada.
authors.forename: Monika
authors.initials: M
authors.lastname: Krzyzanowska
authors.affiliation: Department of Medical Oncology, Princess Margaret Cancer Centre, Toronto, Canada.
authors.forename: Nathasha B
authors.initials: NB
authors.lastname: Leighl
authors.affiliation: Gerstein Science Information Centre, University of Toronto Libraries, Toronto, Canada.
authors.forename: Elena
authors.initials: E
authors.lastname: Springall
authors.affiliation: Department of Medicine and Institute of Health Policy, Management, and Evaluation, University Health Network and University of Toronto, Toronto, Canada.
authors.forename: Shabbir M
authors.initials: SM
authors.lastname: Alibhai
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000523:psychology / Q000628:therapy; D002755:Choice Behavior; D003142:Communication; D015897:Comorbidity; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000191:economics / Q000523:psychology* / Q000628:therapy*; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data; D011471:Prostatic Neoplasms / Q000523:psychology / Q000628:therapy; D036301:Qualitative Research; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects*; D016312:Treatment Refusal / Q000523:psychology / Q000706:statistics & numerical data
chemical_list: D000970:Antineoplastic Agents
keywords: Aged; Cancer; Geriatric oncology; Treatment preferences; Treatment refusal; Treatment-decision-making