02 foubert


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02 foubert

  1. 1. An Ageing society : challenges for oncology nursing ! Implications for Health and Patient education Jan Foubert (BE)
  2. 2. What is Old? <ul><li>Retirement age usually 65 years </li></ul><ul><li>Chronological Vs Physiological </li></ul><ul><li>Clinical senescence @70 years </li></ul><ul><li>Incidence of age-related changes increases 70-75 years </li></ul><ul><li>Frailty >85 years </li></ul>
  3. 3. An Ageing World…. <ul><li>Increasing ageing population world wide </li></ul><ul><li>1998; 390m >65 : likely double in 2025 </li></ul><ul><li>50% of population > 60 years by 2034 </li></ul><ul><li>By 2025 300% increase in older people in developing countries </li></ul><ul><li>By 2050 2billion people >60 years </li></ul>
  4. 4. Living Longer…... <ul><li>Societal expectation of living longer </li></ul><ul><li>Ageist attitudes within Society </li></ul><ul><li>Ageist attitudes within cancer care </li></ul><ul><li>Old age per se does not cause cancer. </li></ul>
  5. 6. Ageing and Cancer <ul><li>Cancer incidence increases sharply with age </li></ul><ul><li>Cancer incidence up to 36 times higher >65years </li></ul><ul><li>60-70% incidence of cancer is in over 65s </li></ul><ul><li>70% of cancer deaths occur in those over 65 years : 35% (m) & 46% (f) in the over 75s </li></ul><ul><li>Parkin et al 1997;Repetto et al 2003 </li></ul>
  6. 7. Age – Related Variations in Cancer Treatment and Care <ul><li>Under diagnosis in older people </li></ul><ul><li>Delayed diagnosis </li></ul><ul><li>Less frequent use of rigorous staging of tumours </li></ul><ul><li>Tendency to under-treat </li></ul><ul><li>Ineffective symptom management </li></ul><ul><li>Lower survival rates </li></ul><ul><li>Goodwin et al., 1996; Ahronheim et al., 1996; Balducci & Lyman, 1997; </li></ul><ul><li>McCaffrey- Boyle, 1997 </li></ul>
  7. 8. Balducci & Extermann 2000
  8. 9. Co-morbidity and Older People with Cancer <ul><li>Older people are likely to have multiple co-morbid conditions </li></ul><ul><li>Co-morbidity is associated with poorer prognosis </li></ul><ul><li>Patients with co-morbid conditions are usually excluded from clinical trials </li></ul><ul><li>Limited understanding of toxicity in patients with co-morbid conditions </li></ul><ul><li>Limited understanding of ongoing management of patients </li></ul>Yancik et al 1998;Extermann 2000;Janssen-Heijnen et al 2000
  9. 10. What do older people require ? <ul><li>Individual approach to care delivery and support </li></ul><ul><li>Tailored package of care and services covering multiple domains of their life </li></ul><ul><li>Respecting their preferences and wider needs </li></ul><ul><li>Cancer care and services at the appropriate time and place in spite of frailties and disabilities </li></ul>
  10. 11. Suggested Reasons for Age – Related Inequalities <ul><li>Clinical Practice: </li></ul><ul><li>Ageist views and stereotypes / Paternalistic assumptions </li></ul><ul><li>Lack of adequate geriatric assessment in cancer care </li></ul><ul><li>Lack of clinical trial data on treatment effectiveness in older people </li></ul><ul><li>Walker et al., 1998; Kearney et al., 2000; Balducci & Beghe, 2000; Repetto & </li></ul><ul><li>Balducci, 2002 </li></ul>
  11. 12. Suggested Reasons for Age – Related Inequalities <ul><li>Research: </li></ul><ul><li>Lack of evidence on older people’s views and wishes </li></ul><ul><li>Lack of a systematic research and clinical framework </li></ul><ul><li>Homogeneity assumptions </li></ul><ul><li>Repetto et al., 1997; Wells & Balducci, 1997; Wedding & Hoffken, 2000; </li></ul><ul><li>Kwakami et al., 2001 </li></ul>
  12. 13. See me…..I’m a person not a disease….. … .I’m 78, have angina and diabetes…have had for nearly 20 years….why are you only interested in my cancer?
  13. 14. <ul><li>Patients with pain have ~3.8 other symptoms </li></ul><ul><li>Patients with fatigue have ~ 4.4 other symptoms </li></ul><ul><li>Patients with pain & fatigue have ~ 6.3 other symptoms </li></ul>Symptoms Experienced 1 Year Post Diagnosis in Elderly People with Cancer Given et al 2001
  14. 15. Perceptions of older people with cancer of information, decision making and treatment <ul><li>Research: </li></ul><ul><li>Older people with cancer are: </li></ul><ul><li>generally content with the information they receive </li></ul><ul><li>not entirely satisfied with the quantity and quality of care and contact </li></ul><ul><li>Older people with cancer present a number of needs regarding decision making, treatment and coping with their illness in general </li></ul><ul><li>Z Chouliara et all, annuals of oncology 15, 2004. </li></ul>
  15. 16. Perceptions of older people with cancer of information, decision making and treatment <ul><li>Older people wish to know their cancer diagnosis and to be kept informed about their treatment progress, but often they do not wish to be told about progression of their illness and their length of survival </li></ul><ul><li>Many issues remain unanswered (example view on the degree and types of desired involvement) </li></ul><ul><li>Z Chouliara et all, annuals of oncology 15, 2004 </li></ul>
  16. 17. What education do nurses require ? <ul><li>Special education in order to meet the diverse and complex needs of patients with cancer and their family = no difference for nurses caring for older people with cancer </li></ul><ul><li>EONS has developed the EONS Post-basic Curriculum in Cancer Nursing, 2005 AND cancer in older people curriculum to provide this knowledge. </li></ul>
  17. 18. EONS Curriculum for Cancer in Older People
  18. 20. Patient education about treatment in cancer care <ul><li>Literature overview : </li></ul><ul><ul><li>Most older people prefer to receive less information on treatment then younger patients </li></ul></ul><ul><ul><li>The needs mat vary according to their cultural background </li></ul></ul><ul><ul><li>Older patients report less need for information on the effect of treatment and cancer on sexuality and body image either for themselves or for their partner </li></ul></ul><ul><ul><li>Information about social life (women) </li></ul></ul><ul><ul><li>Psychological information (men) </li></ul></ul><ul><ul><li>Jansen et all, Cancer Nursing volume 30(4), 2007 </li></ul></ul>
  19. 21. Effective patient education = key to outcomes in terms of more patients satisfactions <ul><li>Good communication requires knowledge of older peoples’ experiences with cancer and their needs </li></ul><ul><li>Nurses should stimulate older patients and give them the opportunity to ask questions </li></ul><ul><li>Nurses should be attentive to the individualistic nature of each older patient’s unique needs </li></ul><ul><li>Maybe we should ask the patients themselves what they need. </li></ul>
  20. 22. Education : viewed by professionals and patients <ul><li>Older patients have more difficulties processing and remembering information </li></ul><ul><li>insufficient exploration of the patients’ personal situation and individual information need </li></ul><ul><li>Lack of sensitive communication , such as showing empathy and emotional support . </li></ul>
  21. 23. Information for children with cancer <ul><li>Resultaten 1 - 10 van circa 9.510.000 voor information for children with cancer ( 0,21 seconds) </li></ul>1 - 10 van circa 1.910.000 voor information for older people with cancer ( 0,17 seconds)
  22. 24. Communication skills
  23. 25. Geriatric oncology has not the best reputation !!!!!!!!! <ul><li>Negative image = competencies are not required since care level is minimal and not technical. </li></ul><ul><li>Negative stereotypes of the elderly are common amongst healthcare professionals </li></ul><ul><li>Wrong = geriatric nursing is complex care and requires knowledge en skills not only in technical skills but also psycho-social competencies. </li></ul><ul><li>Care setting requires leadership skills and organisational skills </li></ul>
  24. 26. IMAGE
  25. 27. This is the preferred image ! <ul><ul><ul><ul><ul><li>ER image </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Status </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Appreciation </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Enough materials and facilities </li></ul></ul></ul></ul></ul>
  26. 28. Shortage of leaders and leadership Mentor’s and role models in geriatric oncology are a key component to attract young nurses into geriatrics Those role models like their job, take care of themselves and respect and love the people they care for Developing future mentors and role models: one of our greatest challenges Clarke 2000; Mahoney 2001
  27. 29. Conclusion <ul><li>Future research is needed to investigate : </li></ul><ul><ul><li>the needs of older patients with cancer and the influences of age related changes in cognitive, physical and psychosocial functioning </li></ul></ul><ul><ul><li>A better understanding of age-related needs of older individuals during communication about cancer treatment is critical for providing high-quality care and may prevent the risk of under treatment . </li></ul></ul>
  28. 30. conclusion <ul><li>Education should be more tailored to older cancer patients’ individual needs and abilities to explore the required amount and content of information, the treatment goals and expectations. </li></ul><ul><li>Structured information, personally relevant information is summarized and repeated. </li></ul><ul><li>A trustful environment can be realized by the nurses showing empathy, interest and emotional support. </li></ul>
  29. 31. But most of all <ul><li>One day we will be the older patient </li></ul><ul><ul><li>Thank you for your attention and interest </li></ul></ul>