Perceptions of Older Adult Care Among Ambulatory Oncology Nurses.

Abstract

Most cancer treatment is provided in the ambulatory setting; thus, it is important to know what issues ambulatory oncology nurses identify in their practice with older cancer patients as well as resources that are helpful or are needed. The aim of this study was to capture ambulatory oncology nurses' perceptions of the unique aspects of caring for older patients and to present the development process, content validity testing, and psychometric evaluation of a survey designed to denote nurse perceptions of older adult care. An expert panel and 2 focus groups informed the development of a 34-item survey scored on a 5-point Likert-type agreement scale and 2 open-ended questions. Psychometric testing and descriptive statistics summarized the quantitative responses. Using thematic analysis, we identified the themes from the open-ended responses. The survey demonstrated good psychometric qualities. A total of 401 participants, mostly staff from large, academic cancer centers, reported an average total score of 3.76, indicating generally positive perceptions of older adult care. The 269 (67%) open-ended responses were categorized into 4 main themes: concerns over medical issues, the need for specialized services, adequate support systems, and appropriate communication. Although most perceived their geriatric practice environment favorably, nurses recognized the complexity of caring for older adults with cancer. They identified gaps in care, such as the need for geriatric specialists and better community resources, paid by insurance. Nurses need more time in the clinic to address complex advanced care planning, symptom burden and home services of older adults with cancer. Each institution should seek feedback from nurses to guide resource allocation.