Exploring Determinants of Compassionate Cancer Care in Older Adults Using Fuzzy Cognitive Mapping

The growing number of older adults with cancer confront practical and organizational limitations that hinder their ability to obtain care that is adapted to their health status, needs, expectations, and life choices. The integration into practice of evidence-based and institutional recommendations for a geriatric approach and person-centered high-quality care remains incomplete. This study uses an action research design to explore stakeholders' perspectives of the challenges involved in translating the established care priorities into a compassionate geriatric approach in oncology and identify promising pathways to improvement. Fifty-three stakeholders participated in focus groups to create cognitive maps representing perceived relationships between concepts related to compassionate care of older adults with cancer. Combining maps results in a single model constructed in Mental Modeler software to weigh relationships and calculate concept centrality (importance in the model). The model represents stakeholders' collective perspective of the determinants of compassionate care that need to be addressed at different decision-making levels. The results reveal pathways to improvement at systemic, organizational, practice, and societal levels. These include connecting policies on ageing and national cancer programs, addressing fragmented care through interdisciplinary teamwork, promoting person-centered care, cultivating relational proximity, and combatting ageism. Translating evidence-based practices and priority orientations into compassionate care rests on collective capacities across multiple providers to address the whole person and their unique trajectory.