A Randomized Trial of Real-Time Geriatric Assessment Reporting in Nonelectively Hospitalized Older Adults with Cancer.
Cancer and aging
Geriatric assessment
Geriatric oncology
Journal
The oncologist
ISSN: 1549-490X
Titre abrégé: Oncologist
Pays: England
ID NLM: 9607837
Informations de publication
Date de publication:
06 2020
06 2020
Historique:
received:
29
07
2019
accepted:
27
11
2019
pubmed:
28
1
2020
medline:
22
6
2021
entrez:
28
1
2020
Statut:
ppublish
Résumé
Hospitalized older adults have significant geriatric deficits that may lead to poor outcomes. We conducted a randomized trial to investigate the effectiveness of providing clinicians with a real-time geriatric assessment (GA) report in nonelectively hospitalized older patients with cancer. We developed a web-based software platform for administering a modified GA (Cancer 2005;104:1998-2005) to older (>70 years) nonelectively hospitalized patients with pathologically confirmed malignancy. Patients were randomized to have their GA report provided to their treating clinicians (Intervention arm) or not provided (Control arm). Our study included 135 patients, median age 76 years, 52% female, 75% white, 21% black, 79% greater than high school education, 59% married, and 17% living alone. All patients had at least one GA-identified deficit, including physical function deficits (90%), cognitive impairment (22%), >5 comorbidities (28%), polypharmacy (>9 medications; 38%), weight loss ≥10% in the past 6 months (40%), anxiety (32%), or depression (30%). There was no difference between the Intervention (6%) and Control arms (9%) in the proportion of patients who were referred by their clinical team for an intervention to address a deficit (p = .53). Many older nonelectively hospitalized patients with cancer have geriatric deficits that are amenable to evidence-based interventions. Real-time GA reports provided to the care team prior to discharge did not influence provider referral for such interventions. There is a need for systems-level interventions to address deficits in this vulnerable patient population. Geriatric deficits are common in hospitalized older adults with cancer and lead to poor outcomes. Addressing modifiable deficits represents an appealing way to improve outcomes. Widespread geriatrician consultation is impractical owing to resource and personnel constraints. This work tested whether prompt delivery of a mostly self-administered, web-based geriatric assessment report to clinicians improved referral rates for evidence-informed interventions. It confirmed frequent geriatric deficits and high readmission rates in this population but found that real-time geriatric assessment reporting did not influence provider referral for evidence-informed interventions on geriatric assessment identified deficits. These findings highlight the need for systems-level intervention to improve outcomes in this vulnerable patient population.
Sections du résumé
BACKGROUND
Hospitalized older adults have significant geriatric deficits that may lead to poor outcomes. We conducted a randomized trial to investigate the effectiveness of providing clinicians with a real-time geriatric assessment (GA) report in nonelectively hospitalized older patients with cancer.
SUBJECTS, MATERIALS, AND METHODS
We developed a web-based software platform for administering a modified GA (Cancer 2005;104:1998-2005) to older (>70 years) nonelectively hospitalized patients with pathologically confirmed malignancy. Patients were randomized to have their GA report provided to their treating clinicians (Intervention arm) or not provided (Control arm).
RESULTS
Our study included 135 patients, median age 76 years, 52% female, 75% white, 21% black, 79% greater than high school education, 59% married, and 17% living alone. All patients had at least one GA-identified deficit, including physical function deficits (90%), cognitive impairment (22%), >5 comorbidities (28%), polypharmacy (>9 medications; 38%), weight loss ≥10% in the past 6 months (40%), anxiety (32%), or depression (30%). There was no difference between the Intervention (6%) and Control arms (9%) in the proportion of patients who were referred by their clinical team for an intervention to address a deficit (p = .53).
CONCLUSION
Many older nonelectively hospitalized patients with cancer have geriatric deficits that are amenable to evidence-based interventions. Real-time GA reports provided to the care team prior to discharge did not influence provider referral for such interventions. There is a need for systems-level interventions to address deficits in this vulnerable patient population.
IMPLICATIONS FOR PRACTICE
Geriatric deficits are common in hospitalized older adults with cancer and lead to poor outcomes. Addressing modifiable deficits represents an appealing way to improve outcomes. Widespread geriatrician consultation is impractical owing to resource and personnel constraints. This work tested whether prompt delivery of a mostly self-administered, web-based geriatric assessment report to clinicians improved referral rates for evidence-informed interventions. It confirmed frequent geriatric deficits and high readmission rates in this population but found that real-time geriatric assessment reporting did not influence provider referral for evidence-informed interventions on geriatric assessment identified deficits. These findings highlight the need for systems-level intervention to improve outcomes in this vulnerable patient population.
Identifiants
pubmed: 31985125
doi: 10.1634/theoncologist.2019-0581
pmc: PMC7288650
doi:
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
488-496Subventions
Organisme : NCI NIH HHS
ID : P30 CA016086
Pays : United States
Informations de copyright
© AlphaMed Press 2020.
Références
J Am Geriatr Soc. 2011 Oct;59(10):1837-46
pubmed: 22091497
J Oncol Pract. 2015 Nov;11(6):470-4
pubmed: 26175532
Crit Rev Oncol Hematol. 2010 Jun;74(3):218-24
pubmed: 19709899
Cancer. 2005 Nov 1;104(9):1998-2005
pubmed: 16206252
Oncologist. 2015 Apr;20(4):379-85
pubmed: 25765876
Breast. 2013 Oct;22(5):753-60
pubmed: 23414850
Palliat Support Care. 2007 Jun;5(2):107-14
pubmed: 17578061
J Clin Oncol. 2011 Mar 10;29(8):1022-8
pubmed: 21300923
Crit Rev Oncol Hematol. 2008 May;66(2):163-70
pubmed: 18243726
Arch Gerontol Geriatr. 2013 Nov-Dec;57(3):305-10
pubmed: 23806790
Health Qual Life Outcomes. 2013 Aug 06;11:136
pubmed: 23919897
Oncologist. 2011;16(10):1403-12
pubmed: 21914699
J Geriatr Oncol. 2014 Jul;5(3):245-51
pubmed: 24703978
Oncologist. 2015 Jul;20(7):767-72
pubmed: 26032136
J Am Geriatr Soc. 2000 Dec;48(12):1707-13
pubmed: 11129765