Cultural and Ethical Barriers to Cancer Treatment in Nursing Homes and Educational Strategies: A Scoping Review

SIMPLE SUMMARY: The increasing prevalence of cancer in nursing homes may be explained by the increased incidence of cancer associated with older age combined with treatment effectiveness leading to chronicity of cancer and functional decline related or not to cancer itself or its treatment. It represents a major challenge for paramedical staff poorly equipped to manage active cancer treatments and may be influenced by unconscious agism due to misconception of cancer care in the elderly. The ONCOPAD project aims to develop information and training programs for paramedical staff in nursing homes to demystify the management of cancer in the elderly and improve the quality of care outside the hospital and the quality of life of patients at each stage. Considering the need to adapt the program, a systematic scoping review of the current data was carried out to map educational strategies as well as cultural and ethical barriers associated with the treatment of cancer in nursing homes. ABSTRACT: (1) Background: The aging of the population, the increase in the incidence of cancer with age, and effective chronic oncological treatments all lead to an increased prevalence of cancer in nursing homes. The aim of the present study was to map the cultural and ethical barriers associated with the treatment of cancer and educational strategies in this setting. (2) Methods: A systematic scoping review was conducted until April 2021 in MEDLINE, Embase, and CINAHL. All articles assessing continuum of care, paramedical education, and continuing education in the context of older cancer patients in nursing homes were reviewed. (3) Results: A total of 666 articles were analyzed, of which 65 studies were included. Many factors interfering with the decision to investigate and treat, leading to late- or unstaged disease, palliative-oriented care instead of curative, and a higher risk of unjustified transfers to acute care settings, were identified. The educational strategies explored in this context were generally based on training programs. (4) Conclusions: These results will allow the co-construction of educational tools intended to develop knowledge and skills to improve diagnostic and therapeutic decision-making, the consistency of care, and, ultimately, the quality of life of older cancer patients in nursing homes.