Abstract

Background

Previous studies show that with increasing age, the risk of frailty increases. A measure of frailty that is validated and encompasses objective tests of both cognitive and physical functioning is the Edmonton Frail Scale (EFS). The EFS has not yet been used in Sweden and only rarely in oncological settings.

Aim

The aim was to explore and evaluate how patients with lung cancer (≥ 65 years of age) experience frailty assessment using the EFS and to test the Swedish translation of the EFS.

Materials and methods

The Swedish translation of the EFS was evaluated with think-aloud interviews, where participants verbalized their thinking while completing the EFS. The interviews were analyzed with content analysis. Participants were patients aged ≥65 years treated with oncological treatment for lung cancer.

Results

The 16 participants were in median 73 years of age and 62% were women. Most, 88%, participants understood the questions and instructions in the Swedish version of the EFS. However, the Swedish translation of two questions was revised to avoid misunderstanding.

In this cohort, 56% were not frail, 18% were vulnerable and the rest mildly to moderately frail according to EFS assessment. Half of the participants rated their frailty in accordance with their EFS score, 4 as better and 5 as worse. The majority showed deficits in cognition and physical performance. EFS assessment made the participants reflect on their own frailty, the strategies they used to cope with everyday life, cancer diagnosis and treatment and their need for support.

Conclusion

The revised Swedish version of the EFS has good face validity. Frailty assessment with the EFS can help health staff start meaningful discussions and improve communication with individuals at any level of frailty about their overall goals-of-care, need for support and facilitate shared decisions of care.

Keywords

Frailty, elderly, oncology, cancer