How do people living with dementia make decisions about their cancer care?: A meta-ethnographic systematic review

Objectives Living with comorbid dementia and cancer is linked with communication and decision-making challenges across the cancer care pathway and poor health outcomes. This meta-ethnographic review aimed to explore the experiences of people living with comorbid dementia and cancer (PLWCDC) when making decisions about their cancer care. Method Six databases were searched using terms pertaining to dementia, cancer, decision-making and qualitative experiences. Studies that qualitatively explored cancer care decision-making experiences from the perspective of people living with comorbid dementia and cancer were included. Results Searches yielded 3424 unique records, with ten articles meeting eligibility criteria. After quality assessment, collated data was synthesised using a reciprocal synthesis. This produced four higher-order themes: ‘challenges of processing cancer-related information’, ‘issues of inaccessible information and uninformed consent’, ‘the role of relatives’, and ‘the importance of individualised and consistent care’, drawn together by a core concept of delivering and receiving person-centred cancer care in an inflexible healthcare system. Conclusion Decision-making experiences were complex and multi-layered. Dementia negatively influenced understanding and retention of information. Poor consistency in staffing and complexity of information provided were overwhelming. PLWCDC were not always meaningfully involved in their cancer-care decisions. Individualised, consistent care is required to improve outcomes for this population.