Implementing the 4 Ms in a geriatric oncology clinic to create age friendly cancer care.

BACKGROUND: Over 50 % of cancers occur in people aged 70 and older, and 60 % of all cancer deaths occur in this population. Cancer care for the older adult is complex related to comorbidities, age related changes and various social needs. They also may experience cognitive and physical limitations during their cancer journey. At Moffitt Cancer Center, 49 % of patients seen in clinic, in hospital, in diagnostic and procedure areas are 65 years of age and over. The purpose of this quality project was to craft age friendly cancer care utilizing the 4 Ms framework as a roadmap to enterprise spread at an NCI Designated Comprehensive Cancer Center. METHODS: Each new patient to the Senior Adult Oncology Program receives geriatric screening with SAOP-3, Timed up and Go and asked, "what matters most". The SAOP-3 Geriatric screening tool includes domains for screening depression and cognitive impairment. High risk medications prompt a pharmacy consult for deprescribing opportunities. RESULTS: Since becoming recognized as an AFHS, the 4 M's have been implemented in all inpatient units at 2 hospitals and continue to spread to ambulatory clinics on 4 outpatient sites. Further enterprise spread totals over 5500 geriatric oncology patients were screened utilizing the SAOP-3 screening tool.

"What Matters Most" to Older Adults With Cancer: Advance Care Planning.

Approximately 1 in 3 adults have some type of advance directive. Advance care planning (ACP) is associated with greater use of supportive care services and decreased patient and family stress. Despite this, organizations continue to have difficulty in implementing effective programs for increasing ACP. Increasing knowledge and comfort of the health care team with end-of-life discussions and ACP is essential. Educational efforts should focus on decreasing known barriers to ACP discussions such as discomfort, unclear role, lack of experience, and limited education. Role playing and case discussions taught by geriatric resources nurses can help increase staff knowledge and comfort regarding ACP. Role playing allows staff to think about their own mortality and what will happen in various situations if ACP is not complete. Team members find that once they have completed their own ACP, they are more comfortable discussing ACP with patients and caregivers. Nurses should collaborate with social workers and chaplains for ACP education and discussing what matters most to them. Patients are encouraged to make sure that they provide advance directives to their health care providers. This article shares an interprofessional team approach to improving processes for ACP as a component of "what matters most" to older adults with cancer.