Dr. Warner said oncologists should also be aware that there are an increasing number of third-party care coordination companies that are being established to enable team-based, patient-centered care.

Don Dizon, MD, who is the clinical co-director of gynecologic oncology at Massachusetts General Hospital Cancer Center, agrees with Dr. Warner. He said that information sharing is a dynamic process and that both elders and their caregivers can approach information in different ways. 


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“Particularly noteworthy are the potential unintended consequences of access, which include the potential of accidental disclosure of medical history that might have been unknown to the caregiver, or sharing of medical knowledge with the patient’s providers heretofore unknown to them,” Dr. Dizon told Cancer Therapy Advisor.

“I think the importance of these findings is to validate that control is important regardless of age.”

He said patients want to be in control of decisions and of information, even if it means that filtration is limited. Dr. Dizon said it is important that oncologists assess on a regular basis the capacity of all patients over the age of 75.

“A fit, older patient needs to be treated with respect. Still, it is important to understand that the preferences for shared decision-making are also quite fluid. What may have been the case when we first meet a patient may change dramatically over the span of years that we are caring for them,” said Dr. Dizon.

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Just as social histories are never static, neither are the preferences of caregiver involvement and shared decision-making in patients, especially as they age.

“Other factors are cultural and racial. We need to bear in mind that the social history is important and that it is dynamic. I also think it reminds us that our patient requires being treated with dignity and respect, and that extends to how, when, and to what degree we share their medical information,” said Dr. Dizon.

References

  1. Crotty BH, Walker J, Dierks M, et al. Information sharing preferences of older patients and their families. JAMA Intern Med. July 6, 2015. [Epub ahead of print] doi: 10.1001/jamainternmed.2015.2903.
  2. American Cancer Society. Cancer Facts & Figures 2015. Atlanta, GA: American Cancer Society; 2015.