Healthcare professional preferences in the health and fitness assessment and optimization of older patients facing colorectal cancer surgery

The role of healthcare professionals' attitudes in treatment decision-making for older adults with cancer: A scoping review

INTRODUCTION

The global population of older adults with cancer is increasing, presenting care challenges caused by comorbidity, polypharmacy, and frailty. In response to these complexities, healthcare professionals (HCPs) rely on their own attitudes to a larger extent due to limitations in the treatment evidence for this population. This scoping review aims to explore and describe the attitudes of HCPs in the context of treatment decision-making for older adults with cancer.

MATERIALS AND METHODS

We conducted a scoping review on HCP attitudes or subjective inclinations in the treatment decision-making process for older adults with cancer. PubMed, Embase, Medline, and EBSCO CINAHL Complete were searched using predefined inclusion criteria. A two-step screening process was implemented, conducted by two-reviewer teams.

RESULTS

From 5161 de-duplicated references, 21 studies were retained for analysis (nine qualitative, six quantitative, five mixed methods). Five patterns were observed, highlighting how HCP attitudes can shape consultation dynamics, influence the interpretation of patient factors such as age and comorbidities, and impact communication with older patients. Additionally, HCP background profession and practice environment emerged as influential in shaping both attitudes and decision-making processes.

DISCUSSION

This scoping review describes the role of HCP attitudes in communicating treatment options with older adults with cancer. It suggests the importance of considering the role of attitudes in decision-making when developing educational resources for geriatric-centred communication skills to support shared decision-making practices in the cancer treatment of older adults.

Surgeon preference for treatment allocation in older people facing major gastrointestinal surgery: an application of the discrete choice experiment methodology

AIM

Variation in major gastrointestinal surgery rates in the older population suggests heterogeneity in surgical management. A higher prevalence of comorbidities, frailty and cognitive impairments in the older population may account for some variation. The aim of this study was to determine surgeon preference for major surgery versus conservative management in hypothetical patient scenarios based on key attributes.

METHOD

A survey was designed according to the discrete choice methodology guided by a separate qualitative study. Questions were designed to test for associations between key attributes (age, comorbidity, urgency of presentation, pathology, functional and cognitive status) and treatment preference for major gastrointestinal surgery versus conservative management. The survey consisting of 18 hypothetical scenarios was disseminated electronically to UK gastrointestinal surgeons. Binomial logistic regression was used to identify associations between the attributes and treatment preference.

RESULTS

In total, 103 responses were received after 256 visits to the questionnaire site (response rate 40.2%). Participants answered 1847 out of the 1854 scenarios (99.6%). There was a preference for major surgery in 1112/1847 (60.2%) of all scenarios. Severe comorbidities (OR 0.001, 95% CI 0.000-0.030; P = 0.000), severe cognitive impairment (OR 0.001, 95% CI 0.000-0.033; P = 0.000) and age 85 years and above (OR 0.028, 95% CI 0.005-0.168; P = 0.000) were all significant in the decision not to offer major gastrointestinal surgery.

CONCLUSION

This study has demonstrated variation in surgical treatment preference according to key attributes in hypothetical scenarios. The development of fitness-stratified guidelines may help to reduce variation in surgical practice in the older population.

Cancer care for people with dementia: Literature overview and recommendations for practice and research

As many countries experience population aging, patients with cancer are becoming older and have more preexisting comorbidities, which include prevalent, age-related, chronic conditions such as dementia. People living with dementia (PLWD) are vulnerable to health disparities, and dementia has high potential to complicate and adversely affect care and outcomes across the cancer trajectory. This report offers an overview of dementia and its prevalence among patients with cancer and a summary of the research literature examining cancer care for PLWD. The reviewed research indicates that PLWD are more likely to have cancer diagnosed at an advanced stage, receive no or less extensive cancer treatment, and have poorer survival after a cancer diagnosis. These cancer disparities do not necessarily signify inappropriately later diagnosis or lower treatment of people with dementia as a group, and they are arguably less feasible and appropriate targets for care optimization. The reviewed research indicates that PLWD also have an increased risk of cancer-related emergency presentations, lower quality processes of cancer-related decision making, accessibility-related barriers to cancer investigations and treatment, higher experienced treatment burden and higher caregiver burden for families, and undertreated cancer-related pain. The authors propose that optimal cancer care for PLWD should focus on proactively minimizing these risk areas and thus must be highly person-centered, with holistic decision making, individualized reasonable adjustments to practice, and strong inclusion and support of family carers. Comprehensive recommendations are made for clinical practice and future research to help clinicians and providers deliver best and equitable cancer care for PLWD and their families.

The impact of prehabilitation interventions on affective and functional outcomes for young to midlife adult cancer patients: A systematic review

OBJECTIVE

Cancer remains one of the most enduring health crises of the modern world. Prehabilitation is a relatively new intervention aimed at preparing individuals for the stresses associated with treatment from diagnosis. Prehabilitation can include exercise, psychological and nutrition-based interventions. The present systematic review aimed to assess the efficacy of prehabilitation on affective and functional outcomes for young to midlife adult cancer patients (18-55 years). Outcomes of interest included prehabilitation programme composition, duration, mode of delivery and measures used to determine impact on affective and functional outcomes.

METHODS

The following databases were searched with controlled and free text vocabulary; Psychological Information database (PsychINFO), Culmunated Index to Nursing and Allied Health Literature (CINAHL), Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica Database (EMBASE) and Public MEDLINE (PubMed). Abstract and full-text screening was conducted with a secondary reviewer and final texts were subject to risk of bias analysis.

RESULTS

Thirteen texts were included at full-text. These included data of 797 prehabilitation participants (mean age 53 years) and a large representation of female participants (71% average). Evidence was found for the efficacy of psychological prehabilitation for anxiety reduction. Prehabilitation did not significantly affect health related quality of life. Findings moderately supported the therapeutic validity of exercise prehabilitation for functional outcomes, both in terms of clinical and experimental improvement with respect to the quality of evidence. Variation between all prehabilitation types was observed. There was insufficient evidence to support the efficacy of psychological prehabilitation on stress, distress or depression.

CONCLUSION

Implications for future research are highlighted and then discussed with respect to this young to midlife age group.

Effect of WeChat-Based Health Education Combined with Satir Model on Self-Management Behaviors and Social Adaptation in Colorectal Cancer Patients during the Perioperative Period

Objective

To explore the effect of WeChat-based health education combined with the Satir model on self-management behaviors and social adaptation in colorectal cancer (CRC) patients during the perioperative period.

Methods

A total of 100 CRC patients treated in our hospital from April 2018 to April 2020 were selected as the objects for the retrospective study and divided into the observation group and the reference group according to their admission order, with 50 cases each. The patients in both groups accepted health education based on the WeChat platform, and additionally, those in the observation group received the Satir group intervention on self-approval for 3 months to compare the patients' scores on self-management behaviors, social adaptation, and self-care agency before and after the intervention between the two groups.

Results

Between the observation group and the reference group, the patients' general information, including age, gender ratio, and course of the disease, was not statistically different (P > 0.05). After nursing intervention, the scores on patients' self-management behaviors, social adaptation, and self-care agency were significantly higher in the observation group than in the reference group (P < 0.001).

Conclusion

Combining the WeChat-based health education with the Satir model can improve the self-management awareness in the CRC patients during the perioperative period, enhance their self-care agency and self-management behaviors, and promote their social adaptation, demonstrating that such a nursing intervention model is worthy of clinical promotion.