Robinson Olivia Claire, Surr Claire, Ashley Laura
School of Humanities and Social Sciences, Leeds Beckett University, Leeds, UK.
Faculty of Medicine and Health, School of Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
Psychooncology. 2025 Jun;34(6):e70184. doi: 10.1002/pon.70184.
In the United Kingdom (UK), 1 in 13 people living with dementia also have cancer. At some point, 41.3% of this population group will require care home support. Limited research has examined the care and support needs of people with dementia and comorbid cancer (DCC) in nursing homes (NHs). This study aimed to explore the care experiences of NH residents with DCC, their families, nursing home staff (NHS) and healthcare professionals (HCPs), and to identify challenges and good practices, to develop recommendations for practice improvement.
A focussed ethnography using interviews, observations, informal conversations, and review of care plan documentation. Data were analysed using ethnographically informed reflexive thematic analysis.
Eight HCPs, Six NHS, 5 family caregivers and 7 residents with DCC were recruited from five NHs in Northern England. Two themes were developed: Complexities around cancer referral and treatment decision-making and Relative invisibility of a resident's clinical cancer diagnosis. Findings suggested residents with DCC were not included in best interest decision-making due to the potential distress knowing about a cancer diagnosis would cause. Families, HCPs and NH staff made collective decisions on the behalf of residents. Often cancer referral was deemed not appropriate. Thus, people with dementia had a clinical-only cancer diagnosis, resulting in limited formal information about the cancer in care documentation and staff knowledge. Potential consequences of having a clinical-only cancer diagnosis included: misattributing cancer symptoms to dementia, reactive care responses to cancer symptoms and the possibility of inadequately managed cancer symptoms.
Implementing earlier discussions about feasible care outcomes is crucial. These conversations should include considerations around hospital referral for oncology care or care through palliation in the NH. Without appropriate recognition of a clinical-only cancer diagnosis and support for staff it could lead to advancement of symptoms that might be challenging and less well managed. We outline several recommendations to support NHS to deliver person-centred care to residents with DCC.
在英国，每13名痴呆症患者中就有1人同时患有癌症。在某个阶段，该人群中有41.3%将需要养老院的支持。针对养老院中患有痴呆症和合并癌症（DCC）患者的护理和支持需求的研究有限。本研究旨在探讨养老院中患有DCC的居民、他们的家人、养老院工作人员（NHS）和医疗保健专业人员（HCPs）的护理经历，识别挑战和良好做法，以制定改进实践的建议。
采用聚焦人种志方法，通过访谈、观察、非正式交谈以及查阅护理计划文档进行研究。使用基于人种志的反思性主题分析对数据进行分析。
从英格兰北部的五家养老院招募了8名HCPs、6名NHS、5名家庭照顾者和7名患有DCC的居民。形成了两个主题：癌症转诊和治疗决策的复杂性以及居民临床癌症诊断的相对隐匿性。研究结果表明，由于知晓癌症诊断可能带来的潜在痛苦，患有DCC的居民未被纳入符合其最大利益的决策过程。家人、HCPs和养老院工作人员代表居民做出集体决策。通常认为癌症转诊不合适。因此，痴呆症患者只有临床癌症诊断，这导致护理文档中关于癌症的正式信息有限，工作人员的了解也有限。仅有临床癌症诊断的潜在后果包括：将癌症症状误诊为痴呆症、对癌症症状采取被动护理反应以及癌症症状管理不足的可能性。
尽早开展关于可行护理结果的讨论至关重要。这些讨论应包括关于转至医院接受肿瘤护理或在养老院进行姑息治疗的考虑。如果不能适当认识仅有临床癌症诊断的情况并为工作人员提供支持，可能会导致症状进展，而这些症状可能具有挑战性且管理不善。我们概述了几项建议，以支持NHS为患有DCC的居民提供以患者为中心的护理。
