Box 2.

Themes and illustrative quotes demonstrating the effect of old age on GP and patient decision making

Theme	Subtheme	Illustrative quotes
Old age alone can affect decision making	Possible cancer symptoms are attributed to the ageing process	A GP stated:
		‘I find that there can be a short delay in management, because we tend to trivialise symptoms that can be attributed to age, fatigue, asthenia, maybe a slight anaemia, things that are relatively trivial. We tend to say it’s just age.’ 56
		A patient stated:
		‘It was … a gradual process, which I put down to old age … [and] I’d had a bad back, so I was quite sort of willing to accept that my back hurts a bit.’ 48
	Healthcare professionals may make decisions on behalf of older patients	‘With an elderly patient, certain specialists and general practitioners have a tendency to make the decision on behalf of the patient, which is an important problem.’ 56
	Healthcare professionals’ personal values may be at odds with those of the patient and carers	The carer recalled that the GP stated:
		‘… for what life shall we save him?’
		The carer further reported:
		‘… it was like he didn’t want anything to be done, that there was no point in doing anything, and that we should be satisfied with taking the world as we found it.’ 69
	Old age alone should not delay investigation and referral	A GP stated:
		‘I have folks [in whom] we’re doing certain tests and things well beyond what generally is recommended but I think for good reason … I have a couple patients in their late 80s and 90s where I tell them: “you’re likely to live another decade or two … so we might need to be a little more aggressive … ”.’ 71