The Perceptions of Patients, Carers and Clinicians Relating to SACT Decision-Making in Older People With Cancer: Qualitative Findings From the Electronic Frailty Index (eFI) in Cancer Study

Objective: To explore the perceptions and experiences of patients, carers and clinicians relating to treatment decision-making in older people with cancer, and to investigate the acceptability of the eFI as a tool to influence decisions about SACT.

Methods: Qualitative interviews were conducted with 28 participants (12 clinicians, 10 patients and 6 carers) at an NHS cancer day unit in South East England. Patients were > 60 years and had received at least one cycle of SACT. Data were analysed using framework analysis.

Results: Two themes were identified. Theme one highlighted that the assessment of frailty is a variable and complex task. However, an individualised assessment incorporating a balance between quality of life and the potential benefit of treatment is fundamentally important. Theme two identified that eFI is an acceptable addition to SACT decision-making which must be discussed with the patient and considered within the context of each individual situation.

Conclusion: The eFI is acceptable for use in assessing the frailty of older people with cancer prior to starting SACT. In-depth, individualised assessment prior to SACT is important in this population, but it is not always realistic. Incorporating the eFI into SACT decision-making offers the potential to address this challenge.