Key elements of optimal treatment decision-making for surgeons and older patients with colorectal or pancreatic cancer: A qualitative study |
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| Affiliation: | 1. Department of Geriatrics, Radboud university medical center, Nijmegen, The Netherlands;2. Department of Surgery, Radboud university medical center, Nijmegen, The Netherlands;1. Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway;2. Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Norway;3. European Palliative Care Research Centre (PRC), Department Oncology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway;4. Østfold University College, Norway;5. Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Norway;1. Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA;2. Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA;3. Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA;1. Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany;2. Pharmaceutical Research Associates (PRA) Health Sciences, Mannheim, Germany;3. Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany;4. German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany |
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| Abstract: | ObjectiveTo identify key elements of optimal treatment decision-making for surgeons and older patients with colorectal (CRC) or pancreatic cancer (PC).MethodsSix focus groups with different participants were performed: three with older CRC/PC patients and relatives, and three with physicians. Supplementary in-depth interviews were conducted in another seven patients. Framework analysis was used to identify key elements in decision-making.Results23 physicians, 22 patients and 14 relatives participated. Three interacting components were revealed: preconditions, content and facilitators of decision-making. To provide optimal information about treatments’ impact on an older patient’s daily life, physicians should obtain an overall picture and take into account patients’ frailty. Depending on patients’ preferences and capacities, dividing decision-making into more sessions will be helpful and simultaneously emphasize patients’ own responsibility. GPs may have a valuable contribution because of their background knowledge and supportive role.ConclusionStakeholders identified several crucial elements in the complex surgical decision-making of older CRC/PC patients. Structured qualitative research may also be of great help in optimizing other treatment directed decision-making processes.Practice implicationsSurgeons should be trained in examining preconditions and useful facilitators in decision-making in older CRC/PC patients to optimize its content and to improve the quality of shared care. |
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| Keywords: | Shared decision-making Cancer Elderly Abdominal surgery |
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