Barriers and Facilitators for the Implementation of Geriatric Oncology Principles in Mexico: A Mixed-Methods Study

Abstract

PURPOSE There is limited information regarding the use of the geriatric assessment (GA) for older adults with cancer in developing countries. We aimed to describe geriatric oncology practice among Mexican oncology professionals and to identify barriers and facilitators for the implementation of GA into the routine care of older adults with cancer in Mexico. METHODS We conducted an explanatory sequential mixed-methods study. We administered an online survey to cancer specialists in Mexico about the routine use of GA and barriers for its use. We then conducted online semistructured interviews with survey respondents selected by their use of GA, expanding on barriers and facilitators for performing GA. Descriptive statistical analyses were performed for quantitative data; qualitative data were analyzed inductively through thematic analysis. We developed joint displays to integrate quantitative/qualitative results. RESULTS We obtained 196 survey responses: 37 physicians (18.9%) reported routinely performing a GA. Medical oncologists ( P = .002) and physicians seeing ≤ 10 patients/day ( P = .010) were more likely to use GA. The most frequent barriers for GA use were lack of qualified personnel (49%), limited knowledge (43.9%), and insufficient time (37.2%). In the interviews (n = 22), the limited availability of geriatricians was commonly mentioned. Respondents highlighted the lack of geriatric oncology knowledge among cancer specialists and geriatricians. Saturation of oncology services and a lack of effective referral pathways for GA were also common issues. Facilitators included availability of geriatricians, system/administrative facilitators, presence of a multidisciplinary team, and availability of geriatric oncology education. CONCLUSION The routine use of geriatric oncology principles in Mexico is limited by the availability of qualified personnel and by insufficient knowledge. An educational intervention could improve the implementation of GA in cancer care.

Geriatric Oncology in Portugal: Where We Are and What Comes Next—A Survey of Healthcare Professionals

“…However, only a small percentage of respondents (23.4%) reported using GA and/or geriatric screening tools to assess elderly patients in clinical practice, and surprisingly, 8.1% had never heard of GA. The proportion of physicians who reported performing a GA is comparable to that found in other studies, such as in a survey of cancer providers in the United States (U.S.) (21%) [ 4 ] or a nationwide survey in Mexico (18.9%) [ 20 ]. Studies from European countries, such as Spain, revealed a 31% use of GA in clinical practice [ 21 ], and an older study from the Netherlands showed that 60% of healthcare professionals performed some sort of geriatric evaluation [ 27 ].…”

“…To our knowledge, this is the first survey of its kind in our country, as there were no data reported on this subject so far. Other countries, where knowledge and practices in geriatric oncology were examined by nationwide surveys, revealed a high demand for education, with an overall acceptance that the GA is an evidence-based way to evaluate older adults with cancer, though it is still less frequently used than anticipated [ 4 , 20 , 21 , 22 ].…”

Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Systemic Cancer Therapy: ASCO Guideline Update

“…The review identified 11 relevant publications. 5,6,12,27,[29][30][31][32][33][34] This research has consistently shown that the uptake of GA is generally modest. Thus, in a study of the use and knowledge of GA instruments among US community-based oncologists, Gajra et al 6 found that just 13% of the 349 oncologists surveyed used GA for all of their older patients; 60% of oncologists did not use a formal GA for any of their geriatric patients; and 19% of oncologists reported that they were not aware of any validated GA instruments.…”

“…For the clinical question concerning the role of GA in older adults with cancer to suggest specific interventions to improve clinical outcomes, the primary outcomes of the nine RCTs included completion of planned chemotherapy (n 5 2) 14,19 ; the proportion of patients with grade 3-5 toxicity (n 5 2) 3,4 ; quality of life (n 5 2) 16,17 ; overall survival (n 5 1) 20 ; a composite criterion of 6-month mortality, functional impairment (fall in the Activities of Daily Living [ADL] score ≥2), and weight loss (≥10%; n 5 1) 18 ; and patient satisfaction with communication about agingrelated concerns (n 5 1). 15 A total of 11 publications were identified by the systematic review and form the evidentiary basis for the Clinical Question 2 guideline recommendations concerning which GA tools should be used to predict outcomes, 5,6,12,[27][28][29][30][31][32][33][34] and help inform the development of the PGA. The identified publications include reports published between 2018 and 2022 of seven clinician surveys, 5,6,12,30,[32][33][34] one systematic literature review, 27 and three narrative literature reviews.…”

“…15 A total of 11 publications were identified by the systematic review and form the evidentiary basis for the Clinical Question 2 guideline recommendations concerning which GA tools should be used to predict outcomes, 5,6,12,[27][28][29][30][31][32][33][34] and help inform the development of the PGA. The identified publications include reports published between 2018 and 2022 of seven clinician surveys, 5,6,12,30,[32][33][34] one systematic literature review, 27 and three narrative literature reviews. 28,29,31 Evidence Quality Assessment…”