Self‐management in older people living with cancer and multi‐morbidity: A systematic review and synthesis of qualitative studies

Abstract

Objective
Many older people with cancer live with multimorbidity. Little is understood about the cumulative impact of old age, cancer and multimorbidity on self‐management. This qualitative systematic review and synthesis aimed to identify what influences self‐management from the perspective of older adults living with cancer and multimorbidity.

Methods
Six databases were systematically searched for primary qualitative research reporting older adults' experiences of living with cancer and multimorbidity (eg, Medline, Embase, and CINAHL). A thematic synthesis was guided by Shippee's model of cumulative complexity. Text labelled as results in the included papers was treated as data.

Results
Twenty‐eight studies were included. While the included studies varied in their focus, our analysis highlighted a number of important themes consistent across the studies. Health conditions with the greatest negative impact on independent living assumed the greatest importance, sometimes meaning their cancer was a low priority. Self‐management practices seen as likely to interfere with quality of life were deprioritized unless viewed as necessary to maintain independence. When burden outweighed capacity, people were reluctant to ask for help from others in their social network. The contribution of formal healthcare services to supporting self‐management was relatively peripheral.

Conclusions
Old age and multimorbidity together may complicate self‐management after cancer, threatening health and well‐being, creating burden and diminishing capacity. Older adults prioritized self‐management practices they considered most likely to enable them to continue to live independently.

The protocol was registered with Prospero (CRD42018107272).

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Identifiers

ORCID for Teresa Corbett: orcid.org/0000-0002-5620-5377

ORCID for Amanda Cummings: orcid.org/0000-0002-5743-2774

ORCID for Lynn Calman: orcid.org/0000-0002-9964-6017

ORCID for Vicky Fenerty: orcid.org/0000-0002-1712-5614

ORCID for Claire Foster: orcid.org/0000-0002-4703-8378

ORCID for Alison Richardson: orcid.org/0000-0003-3127-5755

ORCID for Theresa Wiseman: orcid.org/0000-0002-3355-1269

ORCID for Jackie Bridges: orcid.org/0000-0001-6776-736X

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