title: Improving the applicability of guidelines on nonmelanoma skin cancer in frail older adults: a multidisciplinary expert consensus and systematic review of current guidelines.
abstract: BACKGROUND
  Balancing treatment decisions in frail older adults with nonmelanoma skin cancer (NMSC) can be challenging. Clinical practice guidelines (CPGs) could provide assistance.
  
  
  OBJECTIVE
  To collect and prioritize items related to frail older adults with NMSC for integration into CPGs and to assess the current extent of this integration.
  
  
  METHODS
  Items were collected and prioritized by a multidisciplinary working group (29 members) using a modified Delphi procedure and a five-point Likert scale. To assess current integration of these items in CPGs, a systematic review was subsequently performed by two independent reviewers using five medical databases (PubMed, Embase, Cochrane Library, SUMsearch and Trip Database), websites of guideline developers/databases, and (inter)national dermatological societies.
  
  
  RESULTS
  Prioritization of a final 13-item list showed that 'limited life expectancy' (4·5 ± 0·9) and 'treatment goals other than cure' (4·4 ± 0·7) were most desired to be integrated into CPGs; both were included in six (46%) of the CPGs found (n = 13). Attention to 'tumour characteristics' and 'comorbidities' were included in CPGs most often (100% and 77%, respectively).
  
  
  CONCLUSIONS
  More attention to items related to frail older adults in NMSC CPGs is broadly desired, but CPG integration of these items is currently limited. More integration might stimulate more holistic, personalized and patient-centred care in frail older adults.
authors.affiliation: Department of Dermatology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, the Netherlands. Satish.Lubeek@radboudumc.nl.
authors.forename: S F K
authors.initials: SF
authors.lastname: Lubeek
authors.affiliation: Department of Dermatology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, the Netherlands.
authors.forename: R J
authors.initials: RJ
authors.lastname: Borgonjen
authors.affiliation: Department of Dermatology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, the Netherlands.
authors.forename: L J
authors.initials: LJ
authors.lastname: van Vugt
authors.affiliation: Department of Geriatrics, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, the Netherlands.
authors.forename: M G
authors.initials: MG
authors.lastname: Olde Rikkert
authors.affiliation: Department of Dermatology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, the Netherlands.
authors.forename: P C M
authors.initials: PC
authors.lastname: van de Kerkhof
authors.affiliation: Department of Dermatology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, the Netherlands.
authors.forename: M J P
authors.initials: MJ
authors.lastname: Gerritsen
mesh_terms: D000368:Aged; D000066491:Clinical Decision-Making; D032921:Consensus; D005260:Female; D016330:Frail Elderly; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012878:Skin Neoplasms / Q000628:therapy*