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Implementation of geriatric assessment in oncology settings: A systematic realist review

McKenzie, Gordon A.G.; Bullock, Alex F.; Greenley, Sarah L.; Lind, Michael J.; Johnson, Miriam J.; Pearson, Mark


Gordon A.G. McKenzie

Alex F. Bullock

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Professor Michael Lind
Foundation Professor of Oncology/ Head of the Joint Centre for Cancer Studies


Older adults with cancer are more likely to have worse clinical outcomes than their younger counterparts, and shared decision-making can be difficult, due to both complexity from adverse ageing and under-representation in clinical trials. Geriatric assessment (GA) has been increasingly recognised as a predictive and prehabilitative tool for older adults with cancer. However, GA has been notoriously difficult to implement in oncological settings due to workforce, economic, logistical, and practical barriers. We aimed to review the heterogenous literature on implementation of GA in oncology settings to understand the different implementation context configurations of GA and the mechanisms they trigger to enable successful implementation. A systematic realist review was undertaken in two stages: i) systematic searches with structured data extraction combined with iterative key stakeholder consultations to develop programme theories for implementing GA in oncology settings; ii) synthesis to refine programme theories. Medline, Embase, PsycInfo, Cochrane Library, CINAHL, Web of Science, Scopus, ASSIA, Epistemonikos, JBI Database of Systematic Reviews and Implementation Reports, DARE and Health Technology Assessment were searched. Four programme theories were developed from 53 included articles and 20 key stakeholder consultations addressing the major barriers of GA implementation in oncology practice: time (leveraging non-specialists), funding (creating favourable health economics), practicalities (establishing the use of GA in cancer care), and managing limited resources. We demonstrate that a whole system approach is required to improve the implementation of GA in cancer settings. This review will help inform policy decisions regarding implementation of GA and provide a basis for further implementation research.


McKenzie, G. A., Bullock, A. F., Greenley, S. L., Lind, M. J., Johnson, M. J., & Pearson, M. (2021). Implementation of geriatric assessment in oncology settings: A systematic realist review. Journal of Geriatric Oncology, 12(1), 22-33.

Journal Article Type Review
Acceptance Date Jul 6, 2020
Online Publication Date Jul 14, 2020
Publication Date 2021
Deposit Date Nov 13, 2020
Publicly Available Date Jul 15, 2021
Journal Journal of Geriatric Oncology
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 12
Issue 1
Pages 22-33
Keywords Geriatric assessment; Neoplasms; Implementation science
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