| Description |
More ethnically diverse Americans over the age of 65 are living with advanced or recurrent cancer due to medical advances, yet there are fewer data describing the effect of distress on the supportive care needs (SCN) and care coordination in this population. Using a mixed-methods design guided by the Supportive Care Needs Framework and the five domains of the Supportive Care Needs Survey 34, in this study, I described care coordination, distress, and SCN and elicited individual perceptions of SCN and care coordination among ethnically diverse older adults with advanced or recurrent cancer. One hundred patients with advanced or recurrent cancer receiving outpatient care in an urban academic medical center were enrolled (median age 70 years; 69% male; 56% African American). Most reported low distress (< 4, 67%; clinically meaningful distress ≥ 4, 33%). Prevalent SCN were "fear of cancer spreading" (52%), "not being able to do things" (51%), "pain" (46%), and "concerns about the worries of those close to you" (44%). Clinically meaningful distress was more likely for those with increasing physical and daily living needs (95% CI: 1.0, 1.1). Whites reported more distress than African Americans (U = 458, p = .010). Those identifying as mixed race reported more psychological needs than African Americans (U = 82.2, p = .019). To explore findings more completely, 31 semistructured interviews were conducted. Constructed themes showed that patients (a) interpret care coordination as synonymous with trusting relationships and provider communication, (b) are valuable active partners in the healthcare team and that overall their SCN are met, (c) believe race does not play a role in cancer care because cancer strikes randomly, and (d) find inner strength that comes from God and family support. Personal strength, trust, and resilience, despite limited resources, were noted. In summary, nurses and members of the healthcare team should recognize that although older ethnically diverse adults with advanced cancer report low distress, they remain concerned about the spread of their cancer and want to be involved in their care. Patients believe that building trusting relationships and communicating with providers is important, and that this facilitates care coordination. |
