What's on your mind? A qualitative analysis of concerns and self-management strategies among older adults with advanced cancer.

INTRODUCTION

Older adults with cancer are living longer, but their unique concerns and approaches to self-management are not well understood. Self-management strategies (SMS), historically studied in other chronic diseases, are a promising approach for empowering older patients with cancer and reducing their symptom burden. Self-management strategies are behaviors aimed at coping with the physical sequelae of and psychosocial adjustment to life-limiting disease. We sought to characterize the concerns and self-management strategies of older patients with advanced cancer.

MATERIALS AND

METHODS

This was a secondary analysis of N = 179 initial visits conducted by oncology nurses with older adults (age ≥ 60) with advanced solid tumors as part of a primary palliative care trial. All visits were audio-recorded and transcribed. The team conducted a mixed inductive and deductive content analysis informed by the qualitative description framework. All transcripts were dual coded, with disagreements resolved by consensus.

RESULTS

Patients were a mean age of 72±8 years and 51% (92/179) were female. Almost all (99%) patients expressed at least one concern and patients expressed a median of five concerns (range: 1-12), most commonly in the domains of physical (97%), emotional (60%), and functional (59%) well-being. Nearly all patients, 99% (177/179), were using or planning to use a self-management strategy and patients endorsed a median of five self-management strategies (range: 1-13), most commonly related to the domains of physical (82%), emotional (75%), and social (67%) well-being.

DISCUSSION: Older adults express multiple concerns during primary palliative care visits and they are using a variety of self-management strategies to cope with their advanced cancer. Self-management strategies could be a useful tool for future supportive oncology interventions.

TRIAL REGISTRATION: Originally registered with ClinicalTrials.gov on March 7th, 2016, ID# NCT02712229.