Nurse Practitioners' Experiences Navigating Treatment Decision-Making Affecting Older People with Neurocognitive Disorders and Cancer.

Background and PurposeNurse practitioners (NPs) make treatment decisions impacting older people with neurocognitive disorders (NCDs), like mild cognitive impairment and dementia. Research has shown that when this patient population has cancer, they face barriers accessing care, have higher mortality rates and limited involvement in decision-making. Despite their critical role, few NPs have been included in studies exploring treatment decision-making affecting this population. To improve experiences for older people and their families, this study explored NPs' decision-making experiences when individuals were living with an NCD and cancer.MethodsThis qualitative study was informed by interpretive description, a practice-oriented approach. Data collection methods included semi-structured interviews and reflective journaling. Data analysis was iterative with identification and revision of themes that have accompanying illustrations. The research team drew on relevant nursing and practice knowledge to identify meaningful implications for NP practice.ResultsFive themes were identified which included the observation that participants' decision-making was shaped by NPs' knowledge and assumptions. NP participants experienced uncertainty and ethical challenges while needing to creatively navigate health systems. Drawing on nursing knowledge, NPs sought to actively involve older people and their family in decision making.ConclusionNPs experience complex treatment decision-making when older people are living with an NCD and cancer, requiring navigation of multiple factors and challenges. The results showed shared decision-making processes are applied, suggesting that NPs take up relational treatment decision-making practices. However, there is a need for institutional change, further education, and research about NPs experiences in community settings.