Barriers and enablers to the implementation of geriatric approach in cancer care in older French patients and physicians: A mixed method psychosocial multicenter study.

Despite recommendations on frailty screening (FS) and referral to a comprehensive geriatric assessment (CGA) when needed, the average G8 completion rate into Oncological Multidisciplinary Team reports for older patients with cancer barely reached 10% in recent years. As financial and educational incentives are already offered, this study aimed to explore potential psychosocial remaining barriers toward the implementation of the geriatric approach in oncology. This multicenter mixed-method cross-sectional study explored, in both older patients treated for cancer and physicians (MDs), the psychosocial determinants related to "Performing FS" and "Referral to CGA". The quantitative part was based on an online survey sent to the MDs in the 46 hospitals labeled to treat cancer in Normandy, and a self-questionnaire offered to all consecutive eligible older patients aged 70 and above in six participating outpatient clinics. Their perceptions of ageing was examined using the Attitudes Toward Own Ageing (ATOA) and Expectations Regarding Ageing (ERA-12) questionnaires in older patients and MDs, respectively. Face-to-face semi-structured interviews with both stakeholders were led by a social psychologist. The response rate to the physician's survey was 9.94% (n = 51) and seven participated in interviews. Among older patients, 192 (29.4%) completed analyzable paper surveys and nine participated in interviews. Barely half of MDs considered FS and CGA as a norm, three quarters declared using FS and CGA, but almost all had a Positive Attitude and Intention to Implement. Female MDs had a significantly better ERA-12 total score (64.20% vs 49.60% in male, p = .01), and the most experienced (≥20 yrs) had worse expectations (49.15% vs 61.44% in <10 yrs. and 66.39% in 10-19 yrs., p = .02). Older patients having experienced a CGA (vs only FS or neither) had significantly higher Positive Anticipated Emotion (p = .006), Positive Attitude (p = .01), Subjective Norm (p = .03), and Perceived Behavior Control (p = .004) toward CGA referral. However, the qualitative interviews showed that the words "geriatric" and "frailty" remained associated with ageist stereotypes and reluctance. Psychosocial barriers were found both in patients and in physicians toward FS and CGA in cancer treatment decisions. Psychoeducational strategies for both MDs and patients should be reinforced to highlight the benefit of geriatric interventions in oncology.