Healthcare professional preferences in the health and fitness assessment and optimization of older patients facing colorectal cancer surgery

DANIELS, Sarah L., BURTON, Maria, LEE, Matthew J., MOUG, Susan J., KERR, Karen, WILSON, Tim R., BROWN, Steven R. and WYLD, Lynda (2021). Healthcare professional preferences in the health and fitness assessment and optimization of older patients facing colorectal cancer surgery. Colorectal Disease.

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Official URL: https://onlinelibrary.wiley.com/doi/10.1111/codi.1...
Open Access URL: https://onlinelibrary.wiley.com/doi/epdf/10.1111/c... (Published version)
Link to published version:: https://doi.org/10.1111/codi.15758
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    Abstract

    Abstract: Aim: There are few age‐ and fitness‐specific, evidence‐based guidelines for colorectal cancer surgery. The uptake of different assessment and optimization strategies is variable. The aim of this study was to explore healthcare professional opinion about these issues using a mixed methods design. Methods: Semi‐structured qualitative interviews were undertaken with healthcare professionals from a single UK region involved in the treatment, assessment and optimization of colorectal surgery patients. Interviews were analysed using the framework approach. An online questionnaire survey was subsequently designed and disseminated to UK surgeons to quantitatively assess the importance of interview themes. Descriptive statistics were used to analyse questionnaire data. Results: Thirty‐seven healthcare professionals out of 42 approached (response rate 88%) were interviewed across five hospitals in the south Yorkshire region. Three broad themes were developed: attitudes towards treatment of the older patient, methods of assessment of suitability and optimization strategies. The questionnaire was completed by 103 out of an estimated 256 surgeons (estimated response rate 40.2%). There was a difference in opinion regarding the role of major surgery in older patients, particularly when there is coexisting dementia. Assessment was not standardized. Access to optimization strategies was limited, particularly in the emergency setting. Conclusion: There is wide variation in the process of assessment and provision of optimization strategies in UK practice. Lack of evidence‐based guidelines, cost and time constraints restrict the development of services and pathways. Differences in opinion between surgeons towards patients with frailty or dementia may account for some of the variation in colorectal cancer outcomes.

    Item Type: Article
    Additional Information: ** Article version: VoR ** From Wiley via Jisc Publications Router ** Licence for VoR version of this article: http://creativecommons.org/licenses/by-nc/4.0/ **Journal IDs: issn 1462-8910; issn 1463-1318 **Article IDs: publisher-id: codi15758 **History: published 01-07-2021; accepted 18-05-2021; rev-recd 26-04-2021; submitted 18-02-2021
    Uncontrolled Keywords: ORIGINAL ARTICLE, ORIGINAL ARTICLES, clinical practice variation, gastrointestinal surgery, older adults, prehabilitation, surgery
    Identification Number: https://doi.org/10.1111/codi.15758
    SWORD Depositor: Colin Knott
    Depositing User: Colin Knott
    Date Deposited: 02 Jul 2021 14:06
    Last Modified: 02 Jul 2021 14:15
    URI: http://shura.shu.ac.uk/id/eprint/28806

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