Adapting patient priorities care for older adults with non-muscle-invasive bladder cancer: A qualitative inquiry.

INTRODUCTION

Shared decision-making involves understanding a person's goals and healthcare preferences, especially for older adults with cancer. When making treatment decisions, older adults with non-muscle-invasive bladder cancer (NMIBC) face tradeoffs due to aging and multimorbidity. Our objective was to obtain initial feedback from older adults with NMIBC and their urologists to begin adapting an existing written goal-elicitation tool, Patient Priorities Care (PPC), for shared decision-making in NMIBC.

METHODS

We recruited 5 dyads of older adults with NMIBC (age ≥65) paired with their urologists to use PPC and collected demographics. Patients also completed a frailty assessment. Qualitative interviews with participants were conducted to assess modifications needed (n = 10). We calculated descriptive statistics of quantitative data and used Braun and Clarke's six-phase framework and Interpretative Phenomenological Analysis to analyze interview transcripts.

RESULTS

Mean patient age was 76.4 years, and all were males and frail. Urologists had been in practice for an average of 14.8 years. Four themes emerged from the interviews: 1) PPC should be administered periprocedurally and at multiple time points, 2) PPC was appropriate but modifications were needed to the format and to make it specific to NMIBC, 3) PPC helped urologists learn about their patients, and 4) age, multimorbidity, and urinary symptoms contributed to NMIBC treatment decisions.

CONCLUSIONS

In this pilot qualitative study, participants found PPC easy to use with appropriate content, but it required modifications for format and specificity for NMIBC. Next steps include focus groups to further adapt PPC followed by feasibility testing in the clinic.