Expert consensus panel guidelines on geriatric assessment in oncology

O’Donovan, Anita; Mohile, Supriya G.; Leech, Michelle

doi:10.1111/ecc.12302

Cited by 63 publications

(72 citation statements)

References 83 publications

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“…Because of funding limitations, only U.S. experts were included. A parallel effort included experts outside of the U.S., 44 and future work will examine the similarities and differences between expert opinion in different parts of the world. Although the experts did come to consensus regarding many treatment-related decisions, the recommendations were often vague (e.g., “modify treatment”) which likely reflects the limited data available.…”

Section: Discussionmentioning

confidence: 99%

Geriatric Assessment-Guided Care Processes for Older Adults: A Delphi Consensus of Geriatric Oncology Experts

Mohile

Velarde

Hurria

et al. 2015

J Natl Compr Canc Netw

245

180

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Background Structured care processes that provide a framework for how oncologists can incorporate geriatric assessment (GA) into clinical practice could improve outcomes for vulnerable older adults with cancer, a growing population at high risk of toxicity from cancer treatment. We sought to obtain consensus from an expert panel on the use of GA in clinical practice and to develop algorithms of GA-guided care processes. Methods The Delphi technique, a well-recognized structured and reiterative process to reach consensus, was used. Participants were geriatric oncology experts who attended NIH-funded U13 or Cancer and Aging Research Group conferences. Consensus was defined as an interquartile range of ≤2 units, or ≥66.7%, selecting a utility/helpfulness rating of ≥7 on a 10-point Likert scale. For nominal data, consensus was defined as agreement among ≥66.7% of the group. Results From 33 invited, 30 participants completed all three rounds. The majority of experts (75%) used GA in clinical care, and the rest were involved in geriatric oncology research. The panel met consensus that “all patients aged ≥75 years and those who are younger with age-related health concerns” should undergo GA and all domains (function, physical performance, comorbidity/polypharmacy, cognition, nutrition, psychological status, and social support) should be included. Consensus was met for how GA could guide non-oncologic interventions and cancer treatment decisions. Algorithms for GA-guided care processes were developed. Conclusion This Delphi investigation of geriatric oncology experts demonstrated that GA should be performed for older patients with cancer to guide care processes.

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Section: Discussionmentioning

confidence: 99%

Geriatric Assessment-Guided Care Processes for Older Adults: A Delphi Consensus of Geriatric Oncology Experts

Mohile

Velarde

Hurria

et al. 2015

J Natl Compr Canc Netw

245

180

View full text Add to dashboard Cite

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“…Research has shown that NGT is superior to moderated discussions in focus groups and other more structured techniques, because it regards individual differences, accounts for the strength of conviction, and documents the progress toward achievement of consensus [41]. Moreover, NGT is well-documented [42], easy to learn and apply [43], as well as largely applied in health care and nursing [44]. Nominal grouping is a highly structured technique designed to maximize the individual contribution of each respondent.…”

Section: Methodsmentioning

confidence: 99%

Securing the Continuity of Medical Competence in Times of Demographic Change: A Proposal

Hasebrook¹,

Hinkelmann²,

Volkert³

et al. 2016

JMIR Res Protoc

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BackgroundUniversity hospitals make up the backbone of medical and economic services of hospitals in Germany: they qualify specialist physicians, ensure medical research, and provide highly specialized maximum medical care, which other hospitals cannot undertake. In addition to this assignment, medical research and academic teaching must be managed despite a growing shortage of specialist physicians. By the year 2020, the need for the replacement of retired physicians and increased demand will total 30,000 positions. The situation will become more difficult because, on the whole, patients are becoming older and sicker and because specialist physicians are able to find more attractive working conditions in smaller hospitals, abroad, or outside of curative medicine.ObjectiveIn order to retain sufficient qualified employees, major improvements in quality are required in terms of working and training conditions. For this purpose, a sustainable innovation process is necessary, which incorporates solutions from outside of the health care sector in order to be able to learn from experiences and mistakes from other industries. The FacharztPlus project aims to find suitable measures in order to retain specialist physicians for more years after the completion of 5 years of professional training. This should determine the suitability of additional qualifications alongside the professional career and an expertise-related work organization oriented to different stages of life.MethodsStructured interviews, surveys, and repertory grids are used as preparation for cross-industry expert panels to create future work scenarios for university hospitals. Industries involved are harbor logistics (container terminal), airports, and digitized industrial production (“industry 4.0”) because these industries are also facing a shortage of qualified staff and have to respond to rapidly changing demands. Based on the experts’ scenarios, consensus groups will be established in each university hospital trying to reach consensus about the implementation of relevant factors in order to improve employee retention.ResultsWe expect these consensus groups to develop and introduce measures for more structured training procedures, individual and team incentives, organizational guidelines for better recruiting and retention in hospitals, models of flexible and attractive working conditions including shift work and vacation planning, and use of new learning tools (eg, tablet PCs and mobile phones).ConclusionsAll measures are implemented in the Department of Anaesthesiology, Intensive Care, Emergency Care and Pain Medicine at the University Hospital Muenster (UKM) with approximately 150 physicians and in the further 44 departments of the UKM and 22 teaching hospitals, which all together employ more than 5000 physicians. The measures will also be implemented at the university hospitals in Aachen, Rostock, and Greifswald. All decisions and measures will be discussed with representatives from hospital management and professional associations. Results will be...

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“…Cognition may be assessed using screening instruments such tools as the Mini Mental Status Exam, the Montreal Cognitive Assessment or the Blessed Orientation-Memory-Concentration Test. 22,23 The clinician should assess whether the patient has decision-making capacity 24 and whether a surrogate decision-maker has been identified. 23 In addition, older adults with underlying cognitive impairment may be more vulnerable to delirium 25 , whether when exposed to medications that are potentially inappropriate in older adults 26 or during acute illnesses.…”

Section: Geriatric Assessmentmentioning

confidence: 99%

Management of multiple myeloma in older adults: Gaining ground with geriatric assessment

Wildes

Campagnaro

2017

Journal of Geriatric Oncology

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Multiple myeloma increases in incidence with age. With the aging of the population, the number of cases of multiple myeloma diagnosed in older adults each year will nearly double in the next 20 years. The novel therapeutic agents have significantly improved survival in older adults, but their outcomes remain poorer than in younger patients. Older adults may be more vulnerable to toxicity of therapy, resulting in decreased dose intensity and contributing to poorer outcomes. Data are beginning to emerge to aid in identifying which individuals are at greater risk for toxicity of therapy; comorbidities, functional limitations and age over 80 are among the factors associated with greater risk. Geriatric assessment holds promise in the care of older adults with multiple myeloma, both to allow modification of treatment to prevent toxicity, and to identify vulnerabilities that may require intervention. Emerging treatments with low toxicity and attention to individualizing therapy based on geriatric assessment may aid in further improving outcomes in older adults with multiple myeloma.

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Expert consensus panel guidelines on geriatric assessment in oncology

Cited by 63 publications

References 83 publications

Geriatric Assessment-Guided Care Processes for Older Adults: A Delphi Consensus of Geriatric Oncology Experts

Geriatric Assessment-Guided Care Processes for Older Adults: A Delphi Consensus of Geriatric Oncology Experts

Securing the Continuity of Medical Competence in Times of Demographic Change: A Proposal

Management of multiple myeloma in older adults: Gaining ground with geriatric assessment

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