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BMC Geriatrics
Published in: BMC Geriatrics 1/2021

01-12-2021 | Care | Study protocol

Design and rationale of a routine clinical care pathway and prospective cohort study in older patients needing intensive treatment

Authors: Yara van Holstein, Floor J. van Deudekom, Stella Trompet, Iris Postmus, Anna Uit den Boogaard, Marjan J. T. van der Elst, Nienke A. de Glas, Diana van Heemst, Geert Labots, Mariëtte Altena, Marije Slingerland, Gerrit Jan Liefers, Frederiek van den Bos, Jessica M. van der Bol, Gerard J. Blauw, Johanneke E. A. Portielje, Simon P. Mooijaart

Published in: BMC Geriatrics | Issue 1/2021

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Abstract

Background

Treatment decisions concerning older patients can be very challenging and individualised treatment plans are often required in this very heterogeneous group. In 2015 we have implemented a routine clinical care pathway for older patients in need of intensive treatment, including a comprehensive geriatric assessment (CGA) that was used to support clinical decision making. An ongoing prospective cohort study, the Triaging Elderly Needing Treatment (TENT) study, has also been initiated in 2016 for participants in this clinical care pathway, to study associations between geriatric characteristics and outcomes of treatment that are relevant to older patients. The aim of this paper is to describe the implementation and rationale of the routine clinical care pathway and design of the TENT study.

Methods

A routine clinical care pathway has been designed and implemented in multiple hospitals in the Netherlands. Patients aged ≥70 years who are candidates for intensive treatments, such as chemotherapy, (chemo-)radiation therapy or major surgery, undergo frailty screening based on the Geriatric 8 (G-8) questionnaire and the Six-Item Cognitive Impairment Test (6CIT). If screening reveals potential frailty, a CGA is performed. All patients are invited to participate in the TENT study. Clinical data and blood samples for biomarker studies are collected at baseline. During follow-up, information about treatment complications, hospitalisations, functional decline, quality of life and mortality is collected. The primary outcome is the composite endpoint of functional decline or mortality at 1 year.

Discussion

Implementation of a routine clinical care pathway for older patients in need of intensive treatment provides the opportunity to study associations between determinants of frailty and outcomes of treatment. Results of the TENT study will support individualised treatment for future patients.

Trial registration

The study is retrospectively registered at the Netherlands Trial Register (NTR), trial number NL8107. Date of registration: 22-10-2019.
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Metadata
Title
Design and rationale of a routine clinical care pathway and prospective cohort study in older patients needing intensive treatment
Authors
Yara van Holstein
Floor J. van Deudekom
Stella Trompet
Iris Postmus
Anna Uit den Boogaard
Marjan J. T. van der Elst
Nienke A. de Glas
Diana van Heemst
Geert Labots
Mariëtte Altena
Marije Slingerland
Gerrit Jan Liefers
Frederiek van den Bos
Jessica M. van der Bol
Gerard J. Blauw
Johanneke E. A. Portielje
Simon P. Mooijaart
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Geriatrics / Issue 1/2021
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/s12877-020-01975-0

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