While a comprehensive geriatrician assessment (CGA) is recommended to be included within the standard care of older patients with cancer, uptake has been limited in clinical practice. In Australia, despite oncologists acknowledging the value of a geriatrician assessment and review, access and timeliness of this review is a major barrier to use.1
There are often lengthy wait times following referral to a geriatrician, when ideally, this review should occur in a timely manner. It is our understanding that to date, no other studies have structured their workflow to include a geriatrician review prior to the clinic appointment with the oncologist.
Investigating the impact of comprehensive geriatrician assessments
This project sought to investigate the difference in treatment toxicity after 12 months of implementation of the G8 screening tool (G8) or Modified G8 (mG8) during assessment, as well as a referral to a geriatrician with current practice (“eye ball” test) for all lung and colorectal cancer patients aged over 70 years. Through the nursing team using the G8 to undertake an assessment of a patient as soon as they are referred to Shoalhaven Cancer Care Centre, a geriatrician review can be undertaken in a weekly geriatric clinic, which has commenced as part of this project. In practice, by the time a patient attends their clinic appointment with the oncologist, the findings and recommendations of the geriatrician review can be considered like any other scan or test result alongside the oncologist’s assessment of the patient.
Using the Model for Improvement, we mapped our current processes and then added in the CGA step to the flow of patient interactions within our service and formal geriatric review for those patients who required this. After this first phase, we made some tweaks and moved the geriatric review to earlier in the patient journey. We met monthly as a group to track progress. We created a data collection sheet to be able to analyse results. Unfortunately, the project has ended as the geriatrician was unable to continue to give her time to this project. We hope to be able to apply for funding to reinvigorate it in the near future.
78%of patients felt that staff provided them with enough information for them to be able to make decisions about their healthcare.
100%of patients reported that staff listened to their wishes regarding treatment.
1-2 weeksless wait time to see geriatrician. Previous wait times were 4-6 months in private practice or 12 months in the public clinic.
References
- To THM, Soo WK, Lane H, Khattak A, Steer C, Devitt B et al. Utilisation of geriatric assessment in oncology - a survey of Australian medical oncologists. J Geriatr Oncol 2019; 10(2): 216-221; e-pub ahead of print 2018/07/26; doi 10.1016/j.jgo.2018.07.004.
