Involve the patient
Cancer often affects older patients. Because of the overly technical approach to the illness, the patient’s context, preferences, and objectives are rarely if ever taken into account in the decision-making process. As a result, patients run the risk of being offered too little or too much treatment. According to Festen, it is particularly important for vulnerable older patients to be involved in their own treatment plan. People at this stage of life sometimes have different priorities than younger patients when it comes to quality of life. They may not always prioritise life extension, but instead be more interested in retaining their independence or improving their quality of life, even if it means a shorter life expectancy.
Customised treatment advice
Traditionally, decision-making concerning treatment has been disease-oriented and technical. Treatment decisions are taken by a multidisciplinary team with too little attention for the patient’s opinions and context. Sometimes medical specialists don’t have a clear idea of what matters to the patient. In her research, Festen explored a new approach to older cancer patients, one that takes into consideration not only the disease, but also the person suffering from the disease, and what they find important.
In this approach, nurses play a crucial role by interviewing patients at an early stage to obtain a clear image of the patient and their goals and preferences. This interview includes a short geriatric assessment. This information is subsequently shared in a multidisciplinary team meeting attended not only by oncologists, but also by nurses and geriatric internists, so that the treatment devised is ideally suited both to the disease and to the person.
Based on this process, a customised treatment advice is formulated. In 25% of cases, the additional information provided by the nurse led to less intensive treatment, thus deviating from the existing protocol. Despite these adjustments in treatment advice, mortality in the first year was the same for both groups. Patients with an adjusted treatment plan spent an average of 3.5 days less in hospital and the percentage of complications dropped by 22%.
Investing in training nurses
No suitable treatment plan can be formulated without the input of trained nurses who have access to patients and know how to retain and improve quality of life in relation to disease and health. In her thesis, Festen advocates for investing in training oncological nurses to be able to interview patients, and making sure that they have enough time to do so. This will help create a clear image of the patient at the moment when a decision must be taken.