Use of a Delphi process to formulate a pragmatic framework for care planning in older adults with advanced bladder...

New advanced bladder diagnoses usually occur in the 8th or 9th decade of life. Most data on bladder cancer care has been garnered from a younger population. Older adults with cancer are more likely to have comorbid conditions, undetected vulnerabilities, and priorities that value function in comparison to younger adults with cancer. However, functional assessments and value elicitation are not consistently employed at the outset of care planning in this unique population. We proposed the use of an intervention bundle, or framework, to guide early care planning for older adults with advanced bladder cancer to address the delivery of goal-concordant care.

We followed a modified Delphi process to determine the components of the framework. We undertook an initial literature review and then convened a transdisciplinary group of professionals with internationally recognized expertise in urologic oncology (medical and surgical), clinical trial design, geriatric oncology, palliative care, exercise physiology, or cancer rehab. This panel participated in surveys and meetings to determine representative measures for the (1) functional assessment, (2) chemotherapy toxicity estimate, and (3) guided goals of care discussion components of the framework.

The group recommended the short physical performance battery to measure functional status, the Cancer and Aging Research Group chemotherapy toxicity calculator to estimate chemotherapy risks, and the Serious Illness Conversation Guide to elicit patient values and priorities.

This consensus building process utilized evidence-based measures backed by expert consensus to contribute to a pragmatic framework to guide care planning in older adults with advanced bladder cancer.