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Clinical Epidemiology and Ageing

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

Paillaud E, Canoui-Poitrine F, Varnier G, Anfasi-Ebadi N, Guery E, Saint-Jean O, Gisselbrecht M, Aparicio T, Bastuji-Garin S, Laurent M, Caillet P Age Ageing. 2017;46(4):665-671.

<p><b>Background: </b>information of older patients with cancer is crucial to ensure optimal care.</p><p><b>Objectives: </b>to compare older patients with and without cancer regarding their preferences about medical information, decision-making and surrogate designation.</p><p><b>Design: </b>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.</p><p><b>Setting: </b>Henri-Mondor Teaching Hospital in the Paris conurbation, France.</p><p><b>Results: </b>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].</p><p><b>Conclusion: </b>older patients with cancer expressed a strong preference for receiving information and participating in decisions about their care.</p>

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; Odds Ratio; Paris; Patient Care Planning; Patient Preference; Proxy; Surveys and Questionnaires; Third-Party Consent
DOI: 10.1093/ageing/afw256

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