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Geriatric assessment-guided care processes for older adults: A Delphi consensus of geriatric oncology experts

2015
free-to-access
adult-rehab
(Sarah Lyon) #1

Read Full Text for Free: Geriatric assessment-guided care processes for older adults: A Delphi consensus of geriatric oncology experts
Journal: Journal of the National Comprehensive Cancer Network
Year Published: 2015
Ranked 9th on our 2014-2019 list of the 50 most influential articles 1

Article overview for OT practitioners

This article is seeking to establish a consensus among a panel of expert oncologists. These oncologists are considering whether they should include geratric assessments (GAs) during the care of their older cancer patients—and, if so, what those assessments should include.

They posit that GAs are particularly important for older cancer patients, for two reasons:

  • Older cancer patients are at increased risk for adverse outcomes in cancer treatment
  • Older cancer patients are also at increased risk for serious toxicities from the cancer treatments themselves

Unsurprisingly, the panel arrived at a consensus that all cancer patients aged ≥75 years and (as well as those who are younger with “age-related health concerns”) should undergo GAs, and that the following factors should be measured in these assessments:

  • Function
  • Physical performance
  • Comorbidity/polypharmacy
  • Cognition
  • Nutrition
  • Psychological status
  • Social support

In the treatment algorithm established by the article, “The Algorithm of Geriatric Assessment Guided Processes,” OT was specifically mentioned to address deficits in ADLs and iADLS. OT was also mentioned to address “objective physical performance.”

OT was not explicitly mentioned to address cognition, but the Mini Mental State Exam was one of the recommended assessments—and OTs are equipped to administer this assessment.

About the expert panel

The expert panel consisted of 30 physicians, most of whom were practicing oncologists or geriatricians. A few were oncology researchers. The members of this panel all attended NIH-funded U13 or Cancer and Aging Research Group conferences.

How consensus was established

In this study, a three-round Delphi process was performed. The Delphi method is a flexible iterative survey process, and it is often used to transform individual opinions into group consensuses. It is frequently used to bring clarity on issues where exact solutions are unknown.

This study’s three-round Delphi process consisted of brainstorming, narrowing down, and quantification of the opinions of these expert participants.

Documentation

Here’s an example of documentation you could use in your assessment section of your notes:

The article “Geriatric assessment-guided care processes for older adults: A Delphi consensus of geriatric oncology experts” (2015) established occupational therapy intervention as a best practice for older patients who have functional deficits compounding their cancer diagnoses. In light of this patient’s functional deficits, in the following areas, ________, _________, ________, skilled occupational therapy is warranted.

Takeaways

This article establishes OT intervention as a best practice for older patients with cancer who have functional deficits, but more research is needed.

Expert opinion is at the bottom of the research hierarchy pyramid, meaning it is a foundational step in the direction of more research, but more research in needed to establish details about what specific types of OT interventions will benefit these patients the most.

Listen to a summary in podcast form

Find other platforms for listening to the OT Potential Podcast here.

What questions/thoughts does this article raise for you?

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(Sarah Lyon) pinned globally #2
(Monika Lukasiewicz) #3

This is promising and not surprising. In leu of my Mom’s recent experiences with cancer, it is profound that we are in a profession to be of service in such fragile times. This also seems like another possible area of emerging practice. To be totally honest, my mom’s gyno onco knew about OT but not what it is, according to my mom. Next time I get to see this oncologist I’ll educate her more on what we do. With so many of these articles, it seems there is a link back to… educating and building relationships with referral sources. Interesting find @SarahLyon. What is the next step in moving the research up the pyramid?

3 Likes
(Sarah Lyon) #4

I was thinking of you and your mom as someone this article would resonate for. Is there something specific you wish that an OT could have done for your mom during her roughtest months?

The next level of evidence would be a case-study or cohort study.

nhmrc_evidence_hierarchy

1 Like
(Monika Lukasiewicz) #5

Interesting. That’s a great graphic, very helpful. Lucky for her OT was onsite during her roughest months :slight_smile: She did not qualify for home health nor for OT in the hospital after her surgery. What I do think helped the most (and we actually talk about this in the podcast (home health occupational therapy explorer), is when people showed genuine care and knowledge of her story. I know it meant a lot to help her set up her environment for the thing she REALLY wanted to do: paint oil paintings of sunsets. This meant bringing in a table and chair from the garage, setting up supplies and moving over some furniture in the living room for space. It was also helpful to teach her energy conservation and meal prep strategies. If someone lives alone or has decreased appetite, having appetizing and quick (and nutritious) meals is/was huge. What an incredible profession to be part of… Thanks for all these highlights and topics @SarahLyon.

1 Like
(Sarah Lyon) #6

Hey @monika, if you have a chance could you link to the podcast episode where you talk about this? I bet people who are interested in this topic would like to listen!

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(Sarah Lyon) unpinned #7
(Monika Lukasiewicz) #8

Hot off the press. Thanks for your interest Sarah. May it be of service to others and help elevate us into Healthcare 3.0.

1 Like