Implementation of geriatric assessment in older patients with cancer: Facilitators and barriers

Abstract

Introduction: International guidelinesrecommendthe use ofgeriatric assessment (GA) in older patients with cancer. Therefore, a Belgian pilot project (2009–2011) was set up for multicenter implementation of a uniform GA. Project evaluation revealed that the opinion of treating physicians is crucial for further improvement of GA implementation. Objectives: The aim of this study was to identify treating physicians' general experiences and expectations regarding the implementation of geriatric assessment in older patients with cancer. Methods: This survey was carried out in 9 Belgian hospitals, which participated in the national GA implementation project. A newly developed questionnaire was completed by physicians treating older patients with cancer. Data collection comprised hospital data, general respondent data and treating physicians' general experiences and expectations regarding GA. The latter comprised 5 main categories: (i) the trained healthcare worker(s) (THCWs) (i.e. one (or several) medical or paramedical graduate(s) appointed to coordinate the performance of a GA), (ii) the GA population, (iii) the GA domains, (iv) the GA results and geriatric recommendations, (v) importance and feasibility of GA related tasks for THCWs and geriatricians. Descriptive statistics were calculated. Results: Eighty-two physicians from all hospitals participated. The GA team composition varied substantially, with a nurse as core member. GA should ideally be applied on all patients aged 70 years or older, in whom a cancer treatment decision (i.e. in all new cancer cases and all older patients with progressive disease or relapse) is required. Nearly all GA domains (i.e. social status, functionality, falls, fatigue, cognition, depression, nutrition and medication) were reported important or very important. Pain was mainly reported less important within GA. Availability of GA results can be improved, since a third of the respondents stated that it took threeor more days before theresults were available. Several treating physicians also declared that GA results had never or seldom reached them in time. Treating physicians want geriatricians to coordinate geriatric recommendations and expect from THCWs to collect GA data, to report GA results and to follow-up the implementation of geriatric recommendations. Conclusion: Described heterogeneity of a GA team and reported importance of GA domains align with international literature findings. This study adds that GA implementation can be improved through identification of priorities for the THCW and integration of geriatricians to establish geriatric recommendations. A focus of further research should be how availability of GA results can be increased. Disclosure of Interest: None declared.