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Surgery proposals in elderly colorectal cancer patients : a clinical vignette study

Keizer, J. (2016) Surgery proposals in elderly colorectal cancer patients : a clinical vignette study.

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Abstract:Considering geriatric assessments components in elderly patients can assist physicians in making better treatment proposals in heterogeneous elderly patients. The aim of this study is to explore whether and how additional geriatric assessment information changes treatment proposals for older CRC patients by the multidisciplinary treatment team (MDT). A rigorous mixed method approach was used to identify and select relevant proposal-criteria in older CRC patients. Six attributes (age, cancer stage, comorbidities and functional, cognitive and social status) with different attribute-levels were combined in clinical vignettes using a conjoint analysis rating approach. Descriptive statistics, logistic regression analysis and the coefficient range method were used to analyze the results. Physicians (n=26) proposed surgery in most vignettes (71%) and proposals were changed after considering the additional CGA information in 19% of the clinical vignettes. Mean certainty for treatment proposals was lower after considering the additional CGA information and also in intermediate and worst candidates for surgery. Patients were more likely not to receive surgery when they were older (β:-3,368; p:0,006), had more comorbidity (β:-3,459; p:0,003), had cognitive impairment (β:-2,527; p:0,002) and had social support (β:-2,956; p:0,011). In the coefficient range method the level of comorbidity (25%), age (24%) and social support (21%) had the highest part-worth utilities. Overall tendency to propose surgery was high and additional CGA information has little influence on these proposals. The relative importance of general information and CGA information was similar. Mean certainty decreased after considering the additional CGA information and also in intermediate and worst patient vignettes. Especially in these surgery candidates (identified with geriatric screening tools), CGA information should be considered. This enables making treatment proposals with more attention for elderly specific issues.
Item Type:Essay (Master)
Clients:
Medisch Spectrum Twente, Enschede, Nederland
Faculty:TNW: Science and Technology
Subject:05 communication studies, 44 medicine
Programme:Health Sciences MSc (66851)
Link to this item:http://purl.utwente.nl/essays/71124
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