Chemotherapy treatment decision-making experiences of older adults with cancer, their family members, oncologists and family physicians: a mixed methods study.
Although comorbidities, frailty, and functional impairment are common in older adults (OA) with cancer, little is known about how these factors are considered during the treatment decision-making process by OAs, their families, and health care providers. Our aim was to better understand the treatment decision process from all these perspectives.



A mixed methods multi-perspective longitudinal study using semi-structured interviews and surveys with 29 OAs aged ≥70 years with advanced prostate, breast, colorectal, or lung cancer, 24 of their family members,13 oncologists, and 15 family physicians was conducted. The sample was stratified on age (70-79 and 80+). All interviews were analyzed using thematic analysis.



There was no difference in the treatment decision-making experience based on age. Most OAs felt that they should have the final say in the treatment decision, but strongly valued their oncologists' opinion. "Trust in my oncologist" and "chemotherapy as the last resort to prolong life" were the most important reasons to accept treatment. Families indicated a need to improve communication between them, the patient and the specialist, particularly around goals of treatment. Comorbidity and potential side-effects did not play a major role in the treatment decision-making for patients, families, or oncologists. Family physicians reported no involvement in decisions but desired to be more involved.



This first study using multiple perspectives showed neither frailty nor comorbidity played a role in the treatment decision-making process. Efforts to improve communication were identified as an opportunity that may enhance quality of care. In a mixed methods study multiple perspective study with older adults with cancer, their family members, their oncologist and their family physician we explored the treatment decision making process and found that most older adults were satisfied with their decision. Comorbidity, functional status and frailty did not impact the older adult's or their family members' decision.
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street suite 130, Toronto, ON, M5T1P8, Canada. martine.puts@utoronto.ca.
Martine T E
MT
Puts
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street suite 130, Toronto, ON, M5T1P8, Canada.
Schroder
S
Sattar
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street suite 130, Toronto, ON, M5T1P8, Canada.
Kara
K
McWatters
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street suite 130, Toronto, ON, M5T1P8, Canada.
Katherine
K
Lee
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street suite 130, Toronto, ON, M5T1P8, Canada.
Michael
M
Kulik
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street suite 130, Toronto, ON, M5T1P8, Canada.
Mary-Ellen
ME
MacDonald
Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
Raymond
R
Jang
Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
Eitan
E
Amir
Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
Monika K
MK
Krzyzanowska
Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
Natasha
N
Leighl
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street suite 130, Toronto, ON, M5T1P8, Canada.
Margaret
M
Fitch
Kinghorn Cancer Centre and the Garvan Institute of Medical Research, University of Newsouth Wales, Sydney, Australia.
Anthony M
AM
Joshua
Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
Padraig
P
Warde
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street suite 130, Toronto, ON, M5T1P8, Canada.
Ann E
AE
Tourangeau
Department of Medicine and Institute of Health Policy, Management, and Evaluation, University Health Network and University of Toronto, Toronto, ON, Canada.
Shabbir M H
SM
Alibhai
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D003657:Decision Making; D005190:Family; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009369:Neoplasms / Q000188:drug therapy*; D000072103:Oncologists; D010821:Physicians, Family
Aged; Comorbidity; Decision making; Functional status; Geriatric oncology; Mixed methods study