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Seaman AT, Rowland JH, Werts SJ, Tam RM, Torres TK, Hucek FA, Wickersham KE, Fairman CM, Patel HD, Thomson CA, Hebert JR, Friedman DB. Examining provider perceptions and practices for comprehensive geriatric assessment among cancer survivors: a qualitative study with an implementation science focus. FRONTIERS IN AGING 2023; 4:1305922. [PMID: 38111517 PMCID: PMC10725930 DOI: 10.3389/fragi.2023.1305922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/21/2023] [Indexed: 12/20/2023]
Abstract
Introduction: Cancer rates increase with age, and older cancer survivors have unique medical care needs, making assessment of health status and identification of appropriate supportive resources key to delivery of optimal cancer care. Comprehensive geriatric assessments (CGAs) help determine an older person's functional capabilities as cancer care providers plan treatment and follow-up care. Despite its proven utility, research on implementation of CGA is lacking. Methods: Guided by a qualitative description approach and through interviews with primary care providers and oncologists, our goal was to better understand barriers and facilitators of CGA use and identify training and support needs for implementation. Participants were identified through Cancer Prevention and Control Research Network partner listservs and a national cancer and aging organization. Potential interviewees, contacted via email, were provided with a description of the study purpose. Eight semi-structured interviews were conducted via Zoom, recorded, and transcribed verbatim by a professional transcription service. The interview guide explored providers' knowledge and use of CGAs. For codebook development, three representative transcripts were independently reviewed and coded by four team members. The interpretive process involved reflecting, transcribing, coding, and searching for and identifying themes. Results: Providers shared that, while it would be ideal to administer CGAs with all new patients, they were not always able to do this. Instead, they used brief screening tools or portions of CGAs, or both. There was variability in how CGA domains were assessed; however, all considered CGAs useful and they communicated with patients about their benefits. Identified facilitators of implementation included having clinic champions, an interdisciplinary care team to assist with implementation and referrals for intervention, and institutional resources and buy-in. Barriers noted included limited staff capacity and competing demands on time, provider inexperience, and misaligned institutional priorities. Discussion: Findings can guide solutions for improving the broader and more systematic use of CGAs in the care of older cancer patients. Uptake of processes like CGA to better identify those at risk of poor outcomes and intervening early to modify treatments are critical to maximize the health of the growing population of older cancer survivors living through and beyond their disease.
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Affiliation(s)
- Aaron T. Seaman
- Department of Internal Medicine - General Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
| | - Julia H. Rowland
- Smith Center for Healing and the Arts, Washington, DC, United States
| | - Samantha J. Werts
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
- University of Arizona Cancer Center, Tucson, AZ, United States
| | - Rowena M. Tam
- Physical Therapy Program, School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, United States
- Herbert Wertheim School of Public Health and Human Longevity Science, UC San Diego, San Diego, CA, United States
| | - Tara K. Torres
- University of Arizona Cancer Center, Tucson, AZ, United States
- Department of Psychology, College of Science, University of Arizona, Tucson, AZ, United States
| | - Freda Allyson Hucek
- Office for the Study of Aging, Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Karen E. Wickersham
- College of Nursing, University of South Carolina, Columbia, SC, United States
| | - Ciaran M. Fairman
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Hiten D. Patel
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Cynthia A. Thomson
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
- University of Arizona Cancer Center, Tucson, AZ, United States
| | - James R. Hebert
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Daniela B. Friedman
- Office for the Study of Aging, Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
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