How are Cancer Treatment Recommendations and Decisions Reached with/ For older adults with dementia?

In healthcare, health risk assessments are influenced by technical ‘objective’ measurements of the physical body and disease; the values that underlie professional practices; 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 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. This exposes that healthcare workers and professionals view dementia in diverse ways, which are influenced by subjective understandings of the older adult’s lived experiences of dementia and ageing. These beliefs serve to influence and guide how cancer treatment recommendations and decisions for older people with dementia are reached. This process is further layered with power, whereby the ability to influence such decisions are tempered by one’s professional status and their associated understandings of autonomy (individual versus relational). As a result, this exposes the multifaceted influences on treatment decisions and recommendations, including social constructions of health, illness, and age.