Communication With Older Patients With Cancer Using Geriatric Assessment

1.  Utilizing geriatric assessment in oncology clinical visits for older adults with advanced cancer improves patient-centered communication about aging-related concerns.

Evidence Rating Level: 1 (Excellent)

Patient-centered communication is of critical importance in oncologic care. Previous studies have demonstrated the benefits of interventions that facilitate oncologist-patient communication, but these interventions were not tailored to address aging-related concerns of older patients, despite the fact that older adults generally represent the majority of patients with advanced cancer. Geriatric assessment (GA) uses validated patient-reported and objective measures to capture domains important to older adults. To date, no studies have evaluated the impact of GA on oncology patient satisfaction. The objective of this cluster-randomized, controlled trial was to examine whether the provision of a GA summary and GA-guided recommendations to oncologists can improve communication about aging-related concerns. Five hundred and forty one participants with 414 caregivers across 31 oncology practices were enrolled, and assigned to receive either a tailored GA summary with recommendations for each enrolled patient (intervention), or alerts only for patients meeting criteria for depression or cognitive impairment (usual care) to study the impact on patient satisfaction with communication about aging-related concerns (modified Health Care Climate Questionnaire; score range 0-28, higher scores indicate greater satisfaction). Researchers found that patients in the intervention group were more satisfied with communication about aging-related concerns that those in the usual care group (difference in mean score 1.09 points, 95% CI 0.05 to 2.13 points, p=0.04). Satisfaction remained higher in the intervention group over 6 months (difference in mean score 1.10, 95% CI 0.04 to 2.16, p=0.04). There were significantly more aging-related conversations in the intervention group’s visits (difference 3.59, 95% CI 2.22 to 4.95, p<0.001). Caregivers in the intervention group were more satisfied with communication after the visit (difference 1.05, 95% CI 0.12 to 1.98, p=0.03). However, quality of life outcomes did not differ between groups. Overall, this study supports the integration of a geriatric assessment into community oncology care in terms of patient and caregiver-reported outcomes.

Click to read the study in JAMA Oncology

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