Workforce characteristics and interventions associated with high-quality care and support to older people with cancer: a systematic review

Abstract

ObjectivesTo provide an overview of the evidence base on the effectiveness of workforce interventions for improving the outcomes for older people with cancer, as well as analysing key features of the workforce associated with those improvements.DesignSystematic review.MethodsRelevant databases were searched for primary research, published in English, reporting on older people and cancer and the outcomes of interventions to improve workforce knowledge, attitudes or skills; involving a change in workforce composition and/or skill mix; and/or requiring significant workforce reconfiguration or new roles. Studies were also sought on associations between the composition and characteristics of the cancer care workforce and older people's outcomes. A narrative synthesis was conducted and supported by tabulation of key study data.ResultsStudies (n=24) included 4555 patients aged 60+ from targeted cancer screening to end of life care. Interventions were diverse and two-thirds of the studies were assessed as low quality. Only two studies directly targeted workforce knowledge and skills and only two studies addressed the nature of workforce features related to improved outcomes. Interventions focused on discrete groups of older people with specific needs offering guidance or psychological support were more effective than those broadly targeting survival outcomes. Advanced Practice Nursing roles, voluntary support roles and the involvement of geriatric teams provided some evidence of effectiveness.ConclusionsAn array of workforce interventions focus on improving outcomes for older people with cancer but these are diverse and thinly spread across the cancer journey. Higher quality and larger scale research that focuses on workforce features is now needed to guide developments in this field, and review findings indicate that interventions targeted at specific subgroups of older people with complex needs, and that involve input from advanced practice nurses, geriatric teams and trained volunteers appear most promising.

Position statement on oncology and cancer nursing care for older adults with cancer and their caregivers of the International Society of Geriatric Oncology Nursing and Allied Health Interest Group, the Canadian Association of Nurses in Oncology Oncology & Aging Special Interest Group, and the European Oncology Nursing Society

“…Nurses need the education and support from nursing and organizational leadership to provide high quality oncology nursing care for older adults. Surveys of geriatric oncology nursing knowledge suggests there are currently gaps in education regarding geriatric screening, comprehensive geriatric assessment, and supporting older adults with cancer that need to be addressed [19,21,22,75,76]. One of the biggest barriers to implementing geriatric oncology care for older adults with cancer is the lack of resources such as time [58].…”

“…Rationale: There is a shortage of evidence related to providing high quality cancer care to older adults with cancer and their caregivers, and how to support them during and after their treatments. Such evidence is urgently needed to improve clinical care and patientcentered outcomes [10,75].…”

Effect of an end‐of‐life gerontological nursing education programme on the attitudes and knowledge of clinical nurses: A non‐randomised controlled trial

“…Palliative care is lacking in nursing curricula (Paice et al, ); 75% of nurses working in Japanese EOL facilities for older adults reported never receiving EOL care education (Okumura‐Hiroshige et al, ). Previous studies on EOL care focused on specialised EOL care education, mainly for cancer (Bakitas et al, ; Bridges, Lucas, Wiseman, & Griffiths, ), advanced chronic diseases (Phongtankuel et al, ), and advanced dementia (Raymond et al, ). Since older people receiving EOL care may have multiple diseases, nurses must understand various symptoms’ causes and use multiple assessment and care techniques (Bridges et al, ).…”

“…Previous studies on EOL care focused on specialised EOL care education, mainly for cancer (Bakitas et al, ; Bridges, Lucas, Wiseman, & Griffiths, ), advanced chronic diseases (Phongtankuel et al, ), and advanced dementia (Raymond et al, ). Since older people receiving EOL care may have multiple diseases, nurses must understand various symptoms’ causes and use multiple assessment and care techniques (Bridges et al, ). For example, older cancer patients might have difficulty communicating because of dementia or impaired motor function (Monroe et al, ); nurses must utilise their communication knowledge and symptom assessment for appropriate pain assessment.…”

Contribution of community health volunteers in facilitating mobilization for nutritional screening among adolescents (10-19 years) residing in urban Puducherry, India – an operational research study

“…1 In recent years, many countries have experimented on community participation by involving community health volunteers (CHVs) to expand their health systems. 2,3 There is ample evidence to prove that CHVs can improve access to primary health care, especially among underdeveloped and developing nations. [4][5][6] CHVs can be defined as members who hail from the same locality, has an in-depth understanding of the community structure, language, and existing social beliefs nominated by the community through an active participatory process.…”