Older patients’ experiences of pre-treatment discussions: an analysis of qualitative data from a study of colorectal cancer

It has been suggested that cancer in the elderly is badly treated and that criteria other than chronological age should form the basis for treatment decisions. A study was conducted to discover whether there were age-related differences in the treatment received by a sample of older people with colorectal cancer, and to determine whether any differences were related to patterns of functional status. It was recognised that involvement in treatment decisions may be influenced by contextual factors, therefore additional qualitative data were collected from patients themselves. Responses to semi-structured questions from 337 patients aged 58-95 years were analysed in the light of previous research, which suggests that only a minority want to share equally in medical decision-making with clinicians. Our aim was to determine whether a similar pattern was apparent in patients' responses, and to develop understanding of the determinants of involvement in treatment decision-making. The analysis suggests that patients often lack a sense of agency in the face of disease- and treatment-related events, and that many do not believe they possess the relevant knowledge or authority to act positively in these circumstances. Concerns remain about the losses involved in taking a dependent approach and about the extent to which resisting dependency is possible