Friday, January 9, 2009
Cancer recently devoted an entire supplemental issue to cancer & aging. I'll briefly note a few of the papers.
This paper is a good general review of the clinical & research issues in 'geriatric oncology' - clearly the major perspective here is that chronological age is less important than co-morbidities/functional age, etc.
There is a review of end-of-life care planning and its effects on EOL care/decision-making. It talks about advance directives and their well-described limits, as well as offers a chatty, case-based discussion of what actually constitutes EOL planning/discussion. It has a distinctly psychological focus, and says this towards the end about what's needed in the future:
Policies also must require changes in practitioner performance; it is insufficient to frame policies solely for patients and families. These policies will include changes in medical education and updating how practitioners frame their exchanges with patients. Although being nice, respectful, and a good listener are essential, more is required. Practitioners need a framework that allows them to communicate effectively and to explore how the perceptions and beliefs of a patient and their family about disease and treatment affect how they process the information they receive from oncologists and how they interpret and assign meaning to their ongoing experience with disease and treatment. The understanding emerging from these processes affects patients' treatment preferences and decisions. Patients can frame these gains and losses either abstractly, as days and weeks alive, or concretely, in a realistic view of functioning and surviving to experience significant, vivid, worthwhile life events. Policy must call for and implement educational experiences to achieve this goal.I agree with this, of course, but also note that that's a really tough thing to teach people - some clinicians sort of 'get it' anyway - but those that don't, being taught how to figure out what a patient's understanding is, how they make decisions, their 'narrative' so to speak - that's not a task that can be packaged into a review article or lecture and requires a lot of ongoing time, support, reflection, and mentoring. What I'm saying is that I'd like to know what exact 'policies' the authors have in mind....
The other article is about 'dual process theories' and decision making. It is an incredibly wonkish (written by all PhDs) paper describing psychological research regarding affective (emotional, experiential) decision making and deliberative (cognitive, intellectual) decision making; how age may affect this; and speculating on how this may all affect cancer decision making. If you're interested in this sort of stuff it's a window into the psychological-research world regarding decision making but I can't say it has any easily applicable clinical relevance.