Toward advocacy in cancer care for older adults: survivors have cautious personal actions but bold advice for others.

OBJECTIVES

To examine narratives of personal coping with the cancer experience and compare them with narratives of advice offered to other cancer patients by community-dwelling elderly cancer survivors.

DESIGN

Qualitative and quantitative mixed methods.

SETTING

Community.

PARTICIPANTS

Interviews were conducted with 100 elderly adults who had reported cancer diagnosis from among participants of a panel study of 1,107 community-dwelling elderly adults. Mean age of the sample was 78.7+/-6.8; 62% were female, and 62% were married.

MEASUREMENTS

Three raters identified consistent themes through content analyses of interviews using a staged content analysis process. Themes reporting personal coping were coded separately from advice respondents would offer to others.

RESULTS

Respondents reported themes of personal coping that corresponded well to previously established modes of problem-focused and emotion-focused coping. Themes for personal coping primarily reflected reframing, normalizing, and obtaining social support. Assertive healthcare consumerism and self-care were seldom reported as personal coping strategies but emerged as important coping approaches, along with positive attitude maintenance, in advice offered to others. Length of survivorship was unrelated to coping strategies.

CONCLUSION

Elderly cancer survivors use passive modes of coping and rely on physicians, family, or cognitive acceptance in coping with cancer, but they offer far more proactive advice to other cancer patients. These findings underscore the importance of physician encouragement of older cancer patient initiative and proactivity in expressing views and preferences. Physicians should offer reassurance that elderly patients' questions and initiatives are welcomed.