1. HOW TO USE THE PRESENTATION THAT FOLLOWS (PLEASE DELETE THIS SLIDE!…)
This power-point presentation is designed to help share some of the unique ways in which advocacy can help older people affected by cancer. The focus of the presentation is about ‘hidden’ inequalities that older people affected by cancer may face in relation to their voice, choice and control. These inequalities are likely to be familiar to advocates and are the types of inequalities that advocates try to support older people to overcome.
The presentation is designed to help healthcare professionals to understand what these ‘hidden’ inequalities are and to begin a conversation with them about how working with advocates could help them to address those inequalities.

2. Cancer, Older people and Advocacy project
“Everybody has been trying to fight to keep me going and if it hadn't have been for my advocate to start with I wouldn't be here” (older person affected by cancer)
“No one should have to face cancer alone” (advocate on the Cancer Older People Advocacy programme)

3. .
Hi. This presentation is designed to share how advocacy can help in responding to some ‘hidden inequalities’ that can affect older people with cancer in different ways.
Take a look below to see examples of hidden inequalities that can have a big effect on how people respond to and manage their cancer.
1. Voice
When patients don’t say or do something because they are worried about what others will think about them, or when they have low expectations about how they will manage and respond to their cancer.
2. Choice
When patients can’t choose something they want to do because they don’t have sufficient literacy skills or education, or don’t have access to money, advice or support from friends and family.
3. Control
When somebody else makes a decision for patients when they don’t want them to (such as members of their family or healthcare staff).
Advocates can spot the signs of these inequalities and can often help patients to respond to them…

4. How can Advocates help your patients?
COPA
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COPA .
Advocates know about hidden inequalities.
User .
What are hidden inequalities?
COPA .
These are differences between patients that are often under anyone’s radar but can result in unequal outcomes / experience. Our advocates have experience of identifying and responding to these inequalities. They are often difficult to spot / often seen as ‘normal’ behaviour and can be associated with responses to ‘trauma’. Let me show you some examples.

5. What the advocate did / outcomes What the advocate knows
1. VOICE
What the advocate did / outcomes
The advocate worked through how Deirdre might talk to the doctor about her concerns. Helped to slow down the conversation and decision-making process with the doctor.
Deirdre had time to think about what she really wanted to do. She was able to voice and discuss her concerns to help her make effective decisions.
What the advocate knows
Deirdre has done some research and she doesn’t agree that the operative approach will increase her chances of survival or quality of life. She’s depressed and feels unable to voice her concerns. She’s afraid that the doctor will treat her differently if she doesn’t follow her advice.
Deirdre is 87 years old. She is active and very able. A recent diagnosis of breast cancer has knocked her for six. She doesn’t quite agree with the care plan suggested, but she doesn’t want to cause a fuss.

6. What the advocate did / outcomes What the advocate knows
2. CHOICE
What the advocate did / outcomes
The advocate helped John understand his options and reflect on what he wants. He helped John to frame the questions that he wanted to ask the doctor and the advocate asked some questions directly.
John was able to find answers to questions he wasn’t confident enough to ask on his own. John better understood his choices.
What the advocate knows
John is scared. He feels inferior and that his questions will be seen as daft. He is worried that he can’t talk like the doctor and that he’ll be wasting people’s time.
John is 68 years old. He receives a diagnosis that he has bowel cancer from his GP. After the conversation, he receives a leaflet and is told he can get in touch if he has any questions. He is unsure about what the leaflet is telling him and doesn’t understand his choices.

7. What the advocate did / outcomes What the advocate knows
3. CONTROL
What the advocate did / outcomes
The advocate worked with her family to improve their understanding of her condition and helped Lucy manage her cancer alongside other problems (like her infection).
Lucy’s rights were protected and she built her confidence and control so she would contact the hospital herself without her family preventing it.
What the advocate knows
That her family were calling the shots and this was making her feel like she did not have a voice. That Lucy did complain but they prevented her from calling the hospital.
Lucy is 57 years old. She has been diagnosed with breast cancer. Recently, she did not pick up the phone to call the hospital even though she suspected she had an infection following chemotherapy.

8. Really? That sounds great, how?
PARTNERSHIP – How we can work with you…
COPA
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COPA
We can help you to notice who might need the support of an advocate.
User
Really? That sounds great, how?
COPA .
By helping you understand more about who you think might be:
Vulnerable or lack social support
Need support in understanding their condition
Need help to care for themselves
Lack capacity or confidence to make decisions on their own

9. Yes. I will certainly be feeding this information back to my team!
THE RESULTS OF ADVOCACY?
COPA
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COPA
So, now we know that advocacy could help you in your role, how about we learn about the overall impact advocacy can have on patients’ experience of their cancer care.
User
Yes. I will certainly be feeding this information back to my team!
COPA .
Great! Advocacy works and can really make a difference to the lives of those with cancer. It’s also useful for you to know advocacy can:
Support patients to manage their own care
Support good decision-making and consent
Improve the effective use of resources (e.g. reduce missed appointments), and;
Address inequalities faced by older people (Cancer Strategy)