Abstract
Background: Around 60% of all cancers occur in people over age 65, an age group that is growing and is far from homogenous. Age alone cannot guide treatment approaches or predict survival, but all older adults would benefit from a review of their global health status before deciding on the best treatment option. Older people too often confront longer waits for diagnosis, under- or over-treatment and inadequate follow-up to simultaneously address cancer care and achieve life goals. Best practices in cancer care for older people have been identified, and include professional training, coordination of care and services and participation in research, but these have yet to become standard in health systems. This presentation reports on deliberative discussions on priority actions for improving care and services for older adults living with and beyond cancer.
Approach: We held deliberative discussions among providers, decision-makers and older people with cancer from France and Quebec, along with international experts in geriatric oncology. The question we put out for deliberation was: How can we work towards best practices in a way that considers the local environment and is attentive to the realities and preferences of older people? Deliberative discussion sought to identify, prioritise and link critical factors to enacting best practices in integrated geriatric and cancer care. Data were collected through fuzzy cognitive mapping to integrate real world perspectives with scientific evidence and establish causal relationships between concepts that represent participant perspectives.
Presentations from clinicians, researchers and seniors with cancer provided the 74 participants with a common set of evidence-based and experiential knowledge. Two innovative models of integrated geriatric oncology care were described: one was a dedicated clinic, and the other as a collaborative integrated network. Participants were divided into heterogeneous groups of 6 to 9, including a trained facilitator. Groups were asked to produce a cognitive map of words reflecting the 12 SIOG priorities involved in comprehensive integrated care for older people with cancer. Their objective was to achieve consensus on priorities for action, using boxes and arrows to trace causal links. The maps were subsequently analysed using Mental Modeller software to quantify the centrality of actions.
Results: Cognitive mapping identified pragmatic possibilities for action. The exercise to co-create a common representation of priorities in the care of older adults with cancer brought a clearer understanding of the links between them and offered pathways for improving geriatric oncology care. There will always be challenges in fitting recognized best practices into local realities. The effort involves reaching consensus on the meaning of priorities that support internationally recognized best practices, forming partnerships with seniors living with cancer and paying attention to the local environment. Actors outside the healthcare sector, including municipalities and groups that can help address issues of discrimination, may play a role.
Implications: Enacting evidence-based best practices within a considerate person-centred approach draws on collective capacities within and beyond a given health system. Deliberative discussion and conceptual mapping provide a participatory approach to arrive at recommendations for practice and system improvement.