Preferences about information and decision-making among older patients with and without cancer

Age Ageing. 2017 Jul 1;46(4):665-671. doi: 10.1093/ageing/afw256.

Abstract

Background: information of older patients with cancer is crucial to ensure optimal care.

Objectives: to compare older patients with and without cancer regarding their preferences about medical information, decision-making and surrogate designation.

Design: an intention-to-act questionnaire was completed by patients ≥70 y enroled in the ELderly CAncer PAtients cohort between January and June 2013 and by patients in the same age group enroled in a cross-sectional survey conducted in 2005 in acute geriatric wards.

Setting: Henri-Mondor Teaching Hospital in the Paris conurbation, France.

Results: the group with cancer had 133 patients [mean age, 79.6 ± 6.5 y; 54.9% women]. The main tumour sites were colorectal [24.1%], breast [23.3%] and prostate [15.8%]; 34.8% had metastases. All these patients wanted full information, 74.2% wanted to participate in decisions about their care, 87.2% would designate a family member to serve as a surrogate in life-threatening situations and 15% had already designated a surrogate. Compared to patients without cancer, those with cancer more often wanted to receive information in a life-threatening situation [93.6% versus 79.2%; P < 0.001]. Factors independently associated with patients wanting their informed consent to be obtained for all interventions were having children [adjusted odds ratio (aOR), 2.13; 95% confidence interval, 1.24; 3.66; P = 0.006], higher Mini Mental State Examination score [aORper point, 1.09; 1.02; 1.17], younger age in the group without cancer [aOR>82 y vs. ≤82 y, 0.50; 0.29-0.88] and being cancer-free [≤82 y, aOR, 0.30; 0.14-0.63; >82 y, aOR, 0.41; 0.17-0.97].

Conclusion: older patients with cancer expressed a strong preference for receiving information and participating in decisions about their care.

Keywords: cancer; medical decision-making; medical information; older people; surrogate.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Access to Information*
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Chi-Square Distribution
  • Choice Behavior*
  • Cross-Sectional Studies
  • Female
  • Health Knowledge, Attitudes, Practice*
  • Hospitals, Teaching
  • Humans
  • Logistic Models
  • Male
  • Mental Status and Dementia Tests
  • Multivariate Analysis
  • Neoplasms / psychology*
  • Odds Ratio
  • Paris
  • Patient Care Planning*
  • Patient Preference*
  • Proxy*
  • Surveys and Questionnaires
  • Third-Party Consent*