Inleiding
Multidisciplinaire besluitvorming bij ouderen met kanker
De belangrijke rol van verpleegkundigen bij het passend behandelplan
Summary
Multidisciplinary decision-making in older patients with cancer
Balancing benefit, harm and patients priorities
AIM: To investigate how to best tailor treatments to older cancer patients in order to optimize outcomes and provide patient-centred care.
METHOD: This thesis studied three main topics. 1. Current decision-making in tumour boards was observed. 2. The Outcome Prioritization Tool (OPT) was investigated with older patients. 3. The effects were studied of a new care trajectory that incorporated a nurseled geriatric assessment and goal elicitation, in treatment decision-making.
FINDINGS: When observing decision-making in tumour boards, poor quality of information for psychosocial aspects and patients’ view were found. Nurses were often present, but had very limited contribution to the discussion. The OPT was feasible for most older patients. Maintaining independence was prioritized most often. Medical specialist and general practitioners had limited knowledge of the patients’ main goal. Incorporating patient specific information into multidisciplinary decision-making led to modification of the treatment advice in 27% of patients, mostly towards a less intensive treatment. This resulted in less complications and hospital days, without excess one-year mortality.
DISCUSSION AND CONCLUSION: For tailored decision-making, it is important to combine disease-specific information with patient-centred information. This resulted in less intensive treatment in a quarter of patients with possible better outcomes. Nurses can play an important role.
Keywords: Geriatric Assessment, Decision-making, Older patients, Cancer, Outcome Prioritization Tool