Improving Patient-Caregiver Communication in Older Cancer Patients

A randomized trial assessed the value of a geriatric assessment and whether associated recommendations could improve communication between cancer patients and caregivers about aging-related concerns. This new study concluded that making geriatric assessments a part of oncology clinical visits for older patients was effective.

“Many older adults have unidentified, uncommunicated, and therefore unaddressed aging-related conditions that are associated with morbidity and early mortality,” the study authors wrote “A communication intervention for oncologists who care primarily for older adults—yet lack aging-related expertise—could improve patient and caregiver satisfaction by bringing attention to often-overlooked aging-related conditions.”

Between Oct. 29, 2014, and April 28, 2017, 541 patients aged 70 years or older were recruited from 31 community oncology practices within the University of Rochester National Cancer Institute Community Oncology Research Program. All patients had an advanced solid malignant tumor or lymphoma and at least one impaired geriatric assessment domain. Patients chose one caregiver to take part in the trial. Participating practices were randomized to either receive a tailored geriatric assessment summary that included patient-personalized recommendations (intervention) or only be notified of patients with depressive or cognitive-impaired criteria (usual care).

The main outcome measure was patient satisfaction with communication pertaining to aging-related concerns, evaluated through the modified Health Care Climate Questionnaire; scores ranged from 0 to 28, with higher scores indicating greater satisfaction. Additional outcome measures included the number of aging-related concerns discussed at the visit; quality of life, evaluated using the Functional Assessment of Cancer Therapy scale for patients and the 12-Item Short Form Health Survey for caregivers; and the level of satisfaction among caregivers regarding aging-related patient concerns communication.

The mean (SD) age among the eligible patients (n = 541) was 76.6 (5.2) years; mean (SD) age among the caregivers (n = 414) was 66.5 (12.5) years. The intervention group reported higher levels of satisfaction with communication pertaining to aging-related concerns (difference in mean score, 1.09 points; 95% CI, 0.05-2.13 points; P=0.04). Over six months, satisfaction about communication remined higher in the intervention group (difference in mean score, 1.10; 95% CI, 0.04-2.16; P=0.04). More aging-related conversations took place in the intervention group (difference, 3.59; 95% CI, 2.22-4.95; P<0.001). Intervention group caregivers were also more likely to report higher levels of satisfaction with communication after the visit (difference, 1.05; 95% CI, 0.12-1.98; P=0.03). There were no significant between-group differences in quality of life.

“We’ve shown that we can modify the behavior of oncologists if they have the right tools and guidance,” said study author Supriya Mohile, MD, in a press release. “And when oncologists are better informed about the special needs of their older adult patients, everyone’s experience is much improved.”

The researchers wrote in their conclusion that “a practical and convenient [geriatric assessment] summary with recommendations for aging-sensitive interventions improves patient-centered outcomes and thus should be considered as the standard of care for older patients with cancer.”