Geriatric oncology in the Instagram era: A pilot randomised controlled trial of adjunct PhotoVoice versus usual care to enable cancer supportive care

Introduction: PhotoVoice is a research methodology that facilitates an insight and dialogue into a person's identity, goals, and life using photographs. It is widely used in social sciences and healthcare, including cancer, but has not been explored in geriatric oncology. We examined the feasibility and acceptability of implementing PhotoVoice in older adults at a regional cancer centre in Australia. Materials and Methods: We conducted a pilot feasibility randomised controlled trial from 1 April to 30 August 2021. Inclusion criteria were age ≥ 70, a cancer diagnosis, newly referred to a regional cancer centre, Geriatric-8 score ≤ 14, and informed consent. Patient participants were randomised to PhotoVoice with enhanced supportive care (ESC) or ESC alone. Feasibility of PhotoVoice was defined by patient engagement (submission of four photographs, completion of interviews) and logistical integration into the multidisciplinary team (MDT) process. Acceptability was assessed through inductive thematic analysis of patient interviews and MDT member survey. Summary reports for patients in the PhotoVoice group were discussed at geriatric oncology MDT meetings. Treatment intent was a proxy measure of care decisions. Thematic analysis of interview transcripts was guided by Bronfenbrenner's socioecological framework to understand PhotoVoice with respect to healthcare-seeking behaviours. MDT members completed a feasibility, acceptability, and utility survey on PhotoVoice. Results: Eighteen patients (n = 9 per arm) participated, mean age 79.3 (SD 5.6) years, and six were female. Four of seven MDT members completed the survey. As indicators of feasibility, four patient participants provided four photographs each, four provided more, and one provided two. PhotoVoice complemented ESC but was resource-intensive and time-consuming. Practical considerations for implementation in a busy cancer centre include reducing the number of photographs, streamlining time, and assigning a facilitator for interviews. Acceptability was supported by positive patient reflections and survey responses from MDT members, who valued PhotoVoice's holistic approach but noted timing and efficiency challenges. Patient summary reports were praised for offering richer patient insight, supporting the intervention's relevance and perceived utility. Discussion: PhotoVoice to enhance supportive care in real-world geriatric oncology is feasible and acceptable. Patients and MDTs reported its benefits to enhance patient-centred care. Future research should mitigate the practical constraints of integrating PhotoVoice in practice and optimize effective implementation.<p></p>