- Aging is the greatest risk factor for cancer incidence and mortality. Strong data and expert recommendations support the use of geriatric screening assessments to guide treatment for older adults (>65 years old). Geriatric assessment findings can help in treatment discussions, inform intensity of treatment, and identify supportive care needs. Yet, despite evidenced-based benefits1, geriatric assessments are not implemented routinely in oncologic clinics. Similarly, there are strong data and expert recommendations for assessment of social determinants of health (SDoH) and health behaviors, but consistent assessment and action on SDoH and health behaviors is infrequent. Clinicians aiming to deliver recommended goal-concordant care to older patients – which is informed by a patient’s frailty, SDoH, health behaviors, and mental health – must act without this important contextual information.
- This 2023-2024 pilot aims to integrate assessment of geriatric issues, health behaviors, mental health, and SDoH into an efficient, actionable contextual assessment system for older cancer patients called Integrated Aging Assessment for Action for Cancer Patients (IA3-CP). We will use D&I strategies including co-creation engagement approaches and form-function methods to develop workflow processes that feasibly integrate the IA3-CP into usual initial assessment with the oncology team.
- The Form-Function approach maps the goals or functions of the IA3-CP intervention to specific forms or workflows, thus providing flexibility in how the intervention is delivered across settings. We are using co-creation workshops with clinic personnel and patient partners to refine and prioritize functions, and design the intervention’s forms. See below Table 1 for an initial Functions and Forms matrix:
Table 1. Identified Core Functions and Potential Forms of the IA3-CP system*
|Assess health needs/preferences that may influence cancer treatment decisions
Assessed by MOHR survey of geriatric frailty, SDoH, behavioral and mental health issues and patient preferences. Patient completesIA3-CP via: by self, with staff, with caregiver; at home or in clinic, in English or Spanish
|Integrated and actionable report that synthesizes this information is viewable in the electronic health record
Feedback on IA3-CP data
visually summarized with priorities indicated to patient and clinical team;
either via print out, PDF or in EHR.
Informed patient-clinician interactions– includes standard of care oncology intake and consultation considerations
Clinician (either/both oncologist or other staff) mention IA3-CP data; refer to patient preferences noted; or collaboratively develop patient-centered cancer care plan
|Inform an individualized, supportive and comprehensive cancer care plan
|Care planned shared; referrals made and completed; prioritized behavior changes made
*These functions and forms will be revised based on clinic team/patient input during the Co-creation workshops.