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

Objective: Living with comorbid dementia and cancer is linked with communication and decision-making challenges across the cancer care pathway and poor health outcomes. Oncology services may not be equipped to provide the holistic care required for individuals with dementia. This systematic review aimed to explore the experiences of people living with comorbid dementia and cancer (PLWCDC) when making decisions about their cancer care.

Methods: 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: The search yielded 3424 unique records, with ten articles meeting eligibility criteria. Data was synthesised using meta-ethnography, producing 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’.

Conclusions: Decision-making experiences were complex and multi-layered. Dementia negatively influenced understanding and retention of information related to cancer diagnosis and care. Lack of consistency in staffing and the complexity of information provided were overwhelming. PLWCDC were vulnerable to not being meaningfully involved in their cancer-care decisions, due to the factors identified. Individualised and consistent care is required to improve outcomes for this population.