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Integrated oncogeriatric approach: a systematic review of the literature using concept analysis
Dominique Tremblay1, Kathleen Charlebois, Catherine Terret
1Centre de recherche CSSS Champlain-Charles-Le Moyne, Université de Sherbrooke, École des Sciences infirmières, Longueuil, Québec, Canada.
Objectives:
The purpose of this study was to provide a more precise definition of an integrated oncogeriatric approach (IOGA) through concept analysis.
Data Sources:
The literature was reviewed from January 2005 to April 2011 integrating three broad terms: geriatric oncology, multidisciplinarity and integrated care delivery models.
Study Eligibility Criteria:
Citation selection was based on: (1) elderly cancer patients as the study population; (2) disease management and (3) case studies, intervention studies, assessments, evaluations and studies. Inclusion and exclusion criteria were refined in the course of the literature search.
Interventions:
Initiatives in geriatric oncology that relate to oncology services, social support services and primary care services for elderly cancer patients.
Participants:
Elderly cancer patients aged 70 years old or more.
Study Appraisal And Synthesis Methods:
Rodgers' concept analysis method was used for this study. The analysis was carried out according to thematic analysis based on the elements of the Chronic Care Model.
Results:
The search identified 618 citations. After in-depth appraisal of 327 potential citations, 62 articles that met our inclusion criteria were included in the analysis. Three IOGA main attributes were identified, which constitute IOGA's core aspects: geriatric assessment (GA), comorbidity burden and treatment outcomes. The IOGA concept comprises two broad antecedents: coordinated healthcare delivery and primary supportive care services. Regarding the consequents of an integrated approach in geriatric oncology, the studies reviewed remain inconclusive.
Conclusions:
Our study highlights the pioneering character of the multidimensional IOGA concept, for which the relationship between clinical and organisational attributes, on the one hand, and contextual antecedents, on the other, is not well understood. We have yet to ascertain IOGA's consequents. IMPLICATIONS OF KEY FINDINGS: There is clearly a need for a whole-system approach to change that will provide direction for multilevel (clinical, organisational, strategic) interventions to support interdisciplinary practice, education and research.
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