A Systematic Review of Factors Influencing Older Adults’ Hypothetical Treatment Decisions
Authors: Puts Martine T , Tapscott Brianne , Fitch Margaret , Howell Doris , Monette Johanne , Wan-Chow-Wah Doreen , Krzyzanowska Monika K , Leighl Natasha B , Springall Elena , Alibhai Shabbir M ,   Assistant Professor, Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada,   Registered Nurse, Childrens Hospital of Eastern Ontario, Ontario, Canada,   Expert Lead/Program Consultant, Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada,   Associate Professor, Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada,   RBC Chair Oncology Nursing, Department of Oncology Nursing, Princess Margaret Cancer Centre, Toronto, Ontario, Canada,   Assistant Professor and Geriatrician, Division of Geriatric Medicine, and Co-Director of McGill University/Université de Montreal Solidage Research Group on Frailty and Aging, Jewish General Hospital, Montreal, Quebec, Canada,   Medical Director, Consultation Service for Senior Oncology Patients, Division of Geriatric Medicine, Jewish General Hospital, Montreal, Quebec, Canada,   Medical Oncologist, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada,   Associate Professor, University of Toronto, Toronto, Ontario, Canada,   Medical Oncologist, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada,   Associate Professor, University of Toronto, Toronto, Ontario, Canada,   Acting Coordinator of Resource Sharing, Gerstein Science Information Centre, University of Toronto Libraries, Toronto, Ontario, Canada,   Senior Scientist and Staff Physician, University Health Network and University of Toronto, Toronto, Ontario, Canada
Published: October 2015

Purpose:Cancer affects mostly older adults and although research has shown that a significant proportion of seniors do not receive treatment, little is known about the reasons why. Therefore, we conducted a systematic review of reasons why older adults accept or decline cancer treatments.Design:Systematic review of studies reporting on hypothetical cancer treatment scenarios in older patients published between inception of 10 databases and February 2013.Results:Of 17,343 abstracts reviewed, a total of 12 studies were included (sample size 21 to 511). The willingness to be treated varied by the benefits of treatment (ranging from never to always accepting the treatment), the particular side effects of treatment, and previous treatments received/previous treatment experiences (those who were treated previously were more likely to accept the same treatment). Results showed conflicting findings with regard to the impact of age, education (those with lower/higher age/education wanting more benefits before accepting), and family situation (no effect/those who were single were less likely to accept).Conclusion:Willingness among older adults to be treated was most influenced by the extent of benefits and side effects as well as prior treatment experiences. However, little is known about treatment preferences of the oldest old, those with multimorbidity, and preferences for newer agents.