Self-management by older people living with cancer and multi-morbidity: a qualitative study

Abstract

Purpose Over half of individuals diagnosed with cancer are aged over 70 years, and more than 75% of those with cancer report at least one other medical condition. Having multiple conditions alongside cancer in old age may lower functional status, greater likelihood of treatment complications and less favourable prognoses. This qualitative study explored how older people with long-term chronic conditions manage their health and meet their health-related goals after they have completed treatment for cancer. Methods One-to-one face-to-face qualitative interviews were conducted with 8 older people and 2 informal caregivers based in the UK. Older adults were eligible to participate if they were over 70 and had completed primary cancer treatment with curative intent and had at least one other chronic health condition. A semi-structured interview schedule developed a priori based on Shippee's cumulative complexity model was used. We aimed to explore experiences that could influence self-management, utilisation of healthcare services and health outcomes. A framework analysis was used to describe and interpret the data. Results Four overarching themes were identified in the analysis. These themes related to factors that influenced the everyday health-related workload and capacity of the participants. These factors included their health, resources, and opportunities, as well their motivation and sense of perceived control over their lives. Conclusions Fragmented healthcare systems and relationships with healthcare professionals also influenced the participants' self-management of their health. Our findings highlight the interaction between an individuals' needs, capacity, treatment burden, and the services and resources available to them. These findings support calls to promote person-centred care to better support older adults to manage their health.

‘A real fine balancing act’: A secondary qualitative analysis of power imbalance in comorbid cancer and dementia in an outpatient treatment setting

“…In a study of people with cancer and dementia, Griffiths et al (2021) noted that 'Patients with dementia did not always feel a sense of agency to challenge staff or request changes, perceiving this as immoveable or "the appointment we'd been given"'. When interviewing people with chronic conditions as well as cancer, Corbett et al (2022) found that individuals who normally displayed a sense of active agency in managing their health needs, reported ceding control to healthcare professionals when it came to undergoing treatment for cancer. It can be difficult for individuals to exercise agency within a highly structured system upon which they are reliant.…”

Sociocultural and patient-health care professional related factors influencing self-management of multiethnic patients with multimorbidities: A thematic synthesis

“…Individuals with multimorbidities' life circumstances change with ongoing personal and structural issues resulting in continuing vulnerabilities. The individuals describe financial issues, low income, rural living conditions, unemployment, transportation issues, poor housing conditions, and physical disabilities affecting their self-management of multimorbidities [25][26][27][28][29][30][31][32][33][34][35]. These circumstances made them vulnerable to poor and inadequate self-management.…”

“…Low income [25,26,28,42] Living circumstances and vulnerabilities Contextualized personal and structural vulnerabilities impact access to care and navigation of health care delivery systems Unemployment [25][26][27]33] Financial constraints [25-27, 29-34, 42-45] Limited Transportation [25-27, 30, 32, 34, 35, 38, 43-45] Costly transportation [25,27,35,38] Congested homes many people in a single room or a house [26,42] Out of pocket cost for medications [25,29,30,32,34] Poor housing [26,27,38,42] Rural living [26,32,37,38,42] Living alone [29,38,42] Limited education/literacy level [25,36] Disability prevented from traveling to health care facilities [30,43] Non-sustainable private health insurances [31,32] Scarce health care resources Cutbacks and reductions in insurances [32] Inadequate medical facilities in the community [25,27,28,30,…”

A rural‐urban comparison of self‐management in people living with cancer following primary treatment: A mixed methods study

“…Over the last decade, there has been an international drive towards promoting and supporting self‐management with people living with cancer 18–21 . Self‐management means managing the physical, psychological, social and practical consequences of cancer and its treatment as well as understanding how and when to seek support, recognising signs of disease progression and making lifestyle changes to promote health and wellbeing 22 .…”

“…16,17 Over the last decade, there has been an international drive towards promoting and supporting self-management with people living with cancer. [18][19][20][21] Self-management means managing the physical, psychological, social and practical consequences of cancer and its treatment as well as understanding how and when to seek support, recognising signs of disease progression and making lifestyle changes to promote health and wellbeing. 22 Prominent psycho-social oncology researchers Foster and Fenlon consider engagement with self-management crucial when it comes to the recovery of health and wellbeing following cancer treatment.…”