Assessing the learning needs of the multidisciplinary team on geriatric oncology and frailty

Delivering Palliative and Supportive Care for Older Adults with Cancer: Interactions between Palliative Medicine and Geriatrics

The world's population is aging rapidly, with projections indicating that by 2050 one in six people will be aged ≥65 years. As a result, the number of cancer cases in older people is expected to increase significantly. Palliative care is an essential component of cancer care with a direct impact on quality of life. However, older adults with cancer often suffer from multiple comorbidities, cognitive impairment, and frailty, posing unique challenges in the delivery of palliative care. The complex healthcare needs of older patients with cancer therefore require a comprehensive assessment, including a geriatric evaluation. Collaboration between geriatrics and palliative care can offer a solution to the challenges faced by older people with cancer, since this is a population with overlapping concerns for both disciplines. This review highlights the importance of palliative care for older adults with cancer and the benefits of a multidisciplinary approach. It also addresses the coordination of palliative care and geriatrics for specific symptom management and decision making.

Spreading geriatric oncology culture through professional caregivers: Results of a French massive open online course (MOOC)

Geriatric oncology is based on the synergy between several professionals whose common goal is to improve care for older patients with cancer. This requires sharing a common core of knowledge to facilitate collaboration between them. To date, training in geriatric oncology has been limited in scope and difficult to access for caregivers, particularly nurses and healthcare aides. To meet this need, a massive open online course (MOOC), in geriatric oncology has been developed in France. This kind of course aims to provide simultaneous access for a large number of participants and to foster communication with the pedagogical team through discussion forums. The first session of the MOOC, which has been set up in the Occitania region of France, went online nationwide from March 6 to June 23, 2020. Despite the SARS CoV-2 global health crisis, 1020 people subscribed to the first session and 417 (40.9%) were certified at the end of the course. Most are nurses (35.2%) and work outside Occitania (56.3%). A survey revealed a high satisfaction level regarding relevance of lessons (97.9%), pedagogical quality of teaching team (97.9%), knowledge acquisition (93.6%), meeting learners' needs (90.4%) and practical value of the course (88.3%). This preliminary experience demonstrates the ability of this MOOC to spread the culture of geriatric oncology and the educational potential of this new type of online training.

Never too old to learn new tricks: Surveying Canadian healthcare professionals about learning needs in caring for older adults with cancer

INTRODUCTION

The number of older adults with cancer is growing but little is known about healthcare professionals' (HCPs) perceptions of their readiness to care for older adults with cancer. The Canadian Network on Aging and Cancer together with the Canadian Association of Nurses in Oncology, Oncology and Aging Special Interest Group, conducted a survey to assess geriatric oncology learning needs of Canadian HCPs and explore any differences in needs between nurses and physicians.

METHODS

An online survey was distributed to Canadian HCP, which assessed respondent confidence and desire to learn about domains related to geriatric oncology, current clinical practice and sociodemographic information. Descriptive statistics and chi-square tests were used to characterize participant characteristics, learning needs and compare learning needs of physicians vs. nurses.

RESULTS

Respondents (n = 154) were mostly physicians (n = 78, 51%) or nurses (n = 56, 36%). Respondents reported not being confident addressing mental health issues (75%), polypharmacy (71%), geriatric oncology care models (69%), and return to baseline function post-treatment (67%). Physicians reported more confidence than nurses in managing comorbidities (72% vs. 49%, p < 0.05), having difficult conversations (90% vs. 68%, p < 0.001), and addressing ageism (76% vs. 58%, p < 0.05), while nurses reported more confidence with managing mobility limitations (64% vs 42%, p < 0.05), fall prevention (72% vs. 26%, p < 0.01) and supporting caregivers (74% vs 52%, p < 0.05). Nurses wanted to learn more about geriatric oncology than physicians for 10 domains (p < 0.05).

CONCLUSION

There is a need for interprofessional educational initiatives that address differences between nurses and physicians in clinical areas of confidence and learning needs.

Implementation of geriatric assessment in oncology settings: A systematic realist review

Older adults with cancer are more likely to have worse clinical outcomes than their younger counterparts, and shared decision-making can be difficult, due to both complexity from adverse ageing and under-representation in clinical trials. Geriatric assessment (GA) has been increasingly recognised as a predictive and prehabilitative tool for older adults with cancer. However, GA has been notoriously difficult to implement in oncological settings due to workforce, economic, logistical, and practical barriers. We aimed to review the heterogenous literature on implementation of GA in oncology settings to understand the different implementation context configurations of GA and the mechanisms they trigger to enable successful implementation. A systematic realist review was undertaken in two stages: i) systematic searches with structured data extraction combined with iterative key stakeholder consultations to develop programme theories for implementing GA in oncology settings; ii) synthesis to refine programme theories. Medline, Embase, PsycInfo, Cochrane Library, CINAHL, Web of Science, Scopus, ASSIA, Epistemonikos, JBI Database of Systematic Reviews and Implementation Reports, DARE and Health Technology Assessment were searched. Four programme theories were developed from 53 included articles and 20 key stakeholder consultations addressing the major barriers of GA implementation in oncology practice: time (leveraging non-specialists), funding (creating favourable health economics), practicalities (establishing the use of GA in cancer care), and managing limited resources. We demonstrate that a whole system approach is required to improve the implementation of GA in cancer settings. This review will help inform policy decisions regarding implementation of GA and provide a basis for further implementation research.