Decision-making experiences with older adults following a cancer diagnosis: a systematic review

Lewis, Lucy Anne, Wagland, Richard, Patel, Harnish, Farrington, Naomi and Hunt, Katherine (2025) Decision-making experiences with older adults following a cancer diagnosis: a systematic review. Age and Ageing, 54 (S1). (doi:10.1093/ageing/afae277.109).

Abstract

Introduction
Little evidence exists about decision-making with older adults diagnosed with cancer (Bridges et al 2015). However, older age is associated with changes in physical, social, and psychological health domains in ways that influence treatment decisions potentially impacting on quality and quantity of life. We sought to explore the experiences of older adults, their significant others and healthcare professionals when decisions regarding cancer treatment and support are made.

Methods
Synonyms relating to search terms Cancer, Older People, Complexity and Qualitative research were used to search the databases CINAHL, Medline, Embase and PsychINFO. The Mixed Methods Appraisal Tool (MMAT) identified strengths and limitations of the evidence allowing concurrent appraisal of qualitative, quantitative, and mixed methods studies.

Results
Searches identified 534 articles: 37 studies underwent full text screening, and 15 of these were included. The synthesis identified six themes: Preconditions in decision-making; Identifying frailty and setting goals; Maintaining independence; Information provision; Support during the decision-making process/role distribution; Trust in physicians; Preferences and choice. Most included studies reported the views of the older person, or health care professionals (predominantly physicians/oncologists/surgeons). However, there is a paucity of evidence representing the views of the older adult’s significant other and a dearth of evidence exploring the efforts and contributions of all people involved in the process of decision-making.

Conclusions
Research is needed urgently to understand how and why decisions are made regarding cancer treatment and support, as well as how older adults are involved in these decisions throughout their cancer trajectory. Understanding this would assist healthcare professionals to prioritise individual’s healthcare preferences with the potential to positively influence service delivery and workforce development. This review has informed the research design for The CHOICES study which aims to understand how clinicians, older individuals and their significant others make decisions following a new diagnosis of cancer.

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Contributors

Author: Lucy Anne Lewis

Author: Richard Wagland

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