Cancer treatment decision-making with/ for older adults with dementia: the intersections of autonomy, capital, and power

ABSTRACT

In healthcare, health risk assessments are influenced by technical ‘objective’ measurements of the physical body and disease; the values that underlie professional practices (such as beneficence, non-maleficence, and autonomy); the organisations healthcare professionals work for; and subjective belief systems of individual healthcare professionals. As a result, cancer treatments prescribed for older adults can be tempered by personal views about a patient’s age, and other age-associated health conditions or comorbidities that they may have. Drawing from interviews undertaken with nine key staff members in a large cancer service, we examine how treatment recommendations and decisions are determined when older adults with cancer also have dementia; two health conditions more common in older age. Our analysis reveals two themes that underlie the complicated processes of risk-benefit assessment in treatment decision-making: the unequal distribution of capital and power between health workers; and whether older adults with cancer and dementia are assessed as solely individuals or embedded in supportive social networks (individual versus relational autonomy). This analysis exposes capital and personal beliefs about dementia are implicit in health risk assessments for older adults who have cancer and dementia which, in conjunction with organisational constraints, significantly influence how treatment recommendations and decisions are reached.

KEYWORDS:

• Health risk assessment
• capital
• autonomy
• cancer
• dementia
• ageing

Acknowledgements

The broad study was supported by the Cancer Services Southern Clinical Network and a grant from the School of Nursing, Queensland University of Technology. Data collection and travel for PSC to conduct the interviews was supported by a small grant from the School of Sociology and Social Work, University of Tasmania. We thank the participants for their involvement and time.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Peta S. Cook http://orcid.org/0000-0002-5985-193X

Alexandra L. McCarthy http://orcid.org/0000-0002-8979-2926

Notes

1 In this article, we will use the phrase ‘cognitive impairment’ to refer to dementia and dementia-like diseases including Alzheimer’s disease, Korsakoff’s Syndrome, and Lewy Body Disease. We are not referring to mental illness (such as depression, and mental, developmental and personality disorders) nor forms of temporary dementia that can be halted or reversed through behavioural modifications (such as dietary changes) or medical treatment (such inserting a shunt for normal pressure hydrocephalus) (NIH, 2013).

Additional information

Funding

This work was supported by Queensland University of Technology, School of Nursing; University of Tasmania, School of Sociology and Social Work; Cancer Services Southern Clinical Network.