Blackberry Irene, Boak Jennifer, Rasekaba Tshepo, Steer Christopher
Care Economy Research Institute, La Trobe University, Albury-Wodonga, Victoria, Australia.
John Richards Centre for Ageing Research, La Trobe Rural Health School, La Trobe University, Albury-Wodonga, Victoria, Australia.
Curr Opin Support Palliat Care. 2025 Mar 1;19(1):12-18. doi: 10.1097/SPC.0000000000000740. Epub 2025 Jan 30.
The evidence supporting geriatric assessment (GA) in cancer care is well established, and GA is recommended by the American Society of Clinical Oncology, the International Society of Geriatric Oncology, and other oncology bodies. However, effective implementation of GA remains inadequate. Using selected papers indexed in Medline from the most recent 18 months to July 2024, including two outstanding interest papers, this review aimed to describe enablers and barriers to GA implementation in oncology and contrasts implementation with and without an implementation science framework. Finally, we make recommendations on applying an implementation science framework to facilitate integrating GA in oncology.
Implementation science frameworks have been widely employed in health services research, but their use in geriatric oncology, particularly to guide GA implementation and evaluation, is limited. Lack of time in busy practices coupled with workforce shortages adds to the challenges of GA implementation and adoption. A variety of screening and assessment tools such as the G8, electronic rapid fitness assessment, and Eastern Cooperative Oncology Group are often used in lieu of geriatrician review and to streamline GA. When effectively implemented in oncology, GA informs care and treatment decisions for improved outcomes.
Despite the benefits for older adults, embedding GA into routine clinical practice is critical yet not common practice. The variety of available GA tools, logistics, and individual beliefs are some of the identified barriers to GA adoption in oncology. Enablers include organization readiness, adaptability, communication, and the use of multidisciplinary teams. Further research is needed to examine how implementation science frameworks could provide guidance and structure for successful GA implementation in oncology.
支持在癌症护理中进行老年评估（GA）的证据已充分确立，美国临床肿瘤学会、国际老年肿瘤学会及其他肿瘤学机构均推荐进行老年评估。然而，GA的有效实施仍显不足。本综述利用2022年10月至2024年7月期间Medline索引的精选论文，包括两篇重点关注论文，旨在描述肿瘤学中GA实施的促进因素和障碍，并对比有无实施科学框架下的实施情况。最后，我们就应用实施科学框架以促进GA在肿瘤学中的整合提出建议。
实施科学框架已广泛应用于卫生服务研究，但其在老年肿瘤学中的应用，尤其是用于指导GA的实施和评估，却较为有限。繁忙诊疗工作中时间的缺乏以及劳动力短缺增加了GA实施和采用的挑战。诸如G8、电子快速健康评估和东部肿瘤协作组等多种筛查和评估工具常被用于替代老年科医生的评估，以简化GA流程。当在肿瘤学中有效实施时，GA可为护理和治疗决策提供信息，从而改善治疗效果。
尽管对老年人有益，但将GA纳入常规临床实践至关重要却并非普遍做法。可用的GA工具种类繁多、后勤保障问题以及个人观念等是在肿瘤学中采用GA的一些已确定障碍。促进因素包括组织准备情况、适应性、沟通以及多学科团队的使用。需要进一步研究以探讨实施科学框架如何为GA在肿瘤学中的成功实施提供指导和架构。
