Cancer is frequently a disease of older individuals, and is the second leading cause of death in the United States for those aged 65 and older [1
]. More than 55% of the patients newly diagnosed with cancer are 65 years or older [2
]. Providing patients with adequate information, advice and support around treatment is an important component of care, in which nurses play an important role. The benefits of good patient education for cancer patients may include greater satisfaction with treatment choices, improved ability to cope during the diagnosis, treatment, and post-treatment phases, and reductions in anxiety and mood disturbances [3
]. Given the growing incidence of older individuals and the importance of providing adequate information, this article aims to achieve a better understanding of information needs of older cancer patients surrounding an invasive treatment such as chemotherapy.
The information needs of cancer patients vary considerably across individuals [6
]. Patients desire different types and amounts of information depending on their type of cancer, the extent of disease progression, and their unique personal life circumstances [6
]. Personal relevance determines for a large part whether information will receive attention by a patient or not. Personal relevant information is processed more deeply (e.g. receives increased attention), leading to better comprehension, memory storage and use of the information [9
]. Thus, an indirect effect of tailoring information to the individual patient may be enhancing patients' memory. Recall of information from a medical consultation is important for patients' health and well-being, as it has been associated with decision making [11
], good adherence to recommended treatment [11
] and patient satisfaction [12
]. However, patients forget much of the information provided [6
The relationship between personal relevance of information provided, tailoring the information to patients' needs, the extent to which information is remembered and patients outcomes has been visualised in Figure , showing the conceptual model underlying this study. The expected role of specific characteristics of older cancer patients will be explained below.
Conceptual model of the relationship between 'patients needs' and 'recall of information' among elderly patients.
Older individuals' information needs might differ from the needs of younger patients, since their perceptions of cancer and treatment seem to differ from younger patients, as well as their knowledge of the disease [14
]. In addition, older cancer patients are likely to have concurrent diseases (co-morbidity). The prevalence of functional impairments is also higher among older cancer patients. Functional decline refers to the ability of the individual to perform activities of daily living (ADL), such as using the toilet, dressing and eating, and to perform instrumental activities of daily living (IADL), such as using transportation, shopping, taking medication, and preparing meals [15
]. There is evidence that functional status has a bigger impact than co-morbidity on treatment decisions [16
] and how well patients do after treatment in terms of complications and length of hospital stay [17
]. As functional decline often determines the ability to return home, it is expected to affect patients' and relatives' information and support needs [18
]. Especially, the potential impact of treatment on older people's ability to undertake activities of every day living may be important in terms of what sort of information they want. To add, remembering medical information and treatment recommendations might be a bigger problem for older patients, as cognitive, vision and hearing functions decrease with age [12
]. Besides, older individuals have more difficulty in organizing and storing information [11
], which has a negative influence on recall of information.
Thus, it is crucial to gain insight in the information and support needs of older individuals, to tailor patient education about cancer treatment according to these needs, enhance recall of information and, ultimately, improve other patient outcomes such as satisfaction, medical compliance, coping with illness and well being.
Numerous studies have evaluated cancer patients' information needs and suggested that the vast majority of cancer patients want as much information as possible whether it is good or bad [19
]. However, a recent systematic literature review revealed that hardly any studies investigated the specific needs of older cancer patients surrounding treatment [21
]. The authors therefore included studies in the review in which some of the patients were older (i.e. 65 years or older) and the presence or absence of age differences were reported. They identified 17 studies that met their inclusion criteria, the results of which suggest that the majority of older cancer patients want to receive relevant information about their treatment. Yet, the results also indicate that although older patients prefer to receive information about the most important aspects of the disease and treatment, they are relatively less interested in extensive and detailed information [21
This article describes the views of both older cancer patients and professionals, on patients' specific information needs preceding chemotherapy. The study is part of a larger, prospective study that aims to improve patient education for older cancer patients during nursing consultations preceding chemotherapy. To obtain insight in the views of older cancer patients and professionals, the following research questions were addressed:
1. Which differences between older and younger patients should be taken into account by nurses during patient education?
2. What are the information and support needs of older cancer patients facing chemotherapy treatment?
3. How can older cancer patients' recall of information be enhanced by nurses?