High-risk surgery among older adults: Not-quite shared decision-making

Roo, Ana C. De; Vitous, C. Ann; Rivard, Samantha J.; Bamdad, Michaela C.; Jafri, Sara M.; Byrnes, Mary E.; Suwanabol, Pasithorn A.

doi:10.1016/j.surg.2021.02.005

Cited by 16 publications

(13 citation statements)

References 44 publications

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“…Indeed, our group has demonstrated that most surgeons report focusing on expectation setting and potential operative risks rather than actively seeking patient participation in decision-making. 23 Our study found that the factors associated with regret were different in patients undergoing elective colectomy compared to patients undergoing urgent/emergency colectomy. In the elective setting, adverse events such as prolonged length of stay, development of postoperative complication, and readmissions were associated with higher odds of regret.…”

Section: Discussionmentioning

confidence: 61%

Decisional Regret Among Patients Undergoing Colectomy

Janes

Lussiez

Anderson

et al. 2022

Diseases of the Colon &Amp; Rectum

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BACKGROUND: Patients undergoing colectomy may be at risk for postoperative regret, which is associated with worse quality of life, higher rates of depression, and poorer health outcomes. A better understanding of factors associated with decisional regret may allow surgeons to better tailor preoperative discussions to mitigate the risk of regret. OBJECTIVE:This study aimed to identify factors associated with regret in patients undergoing elective and urgent/emergent colectomy. DESIGN:A retrospective cohort study. SETTING:The Michigan Surgical Quality Collaborative, a 73-hospital collaborative, which collects clinical data on general surgery operations.PATIENTS: Patients aged >18 years who underwent elective or urgent/emergent colectomy between January 2017 and March 2020 and who completed a decision regret survey. MAIN OUTCOME MEASURES:Any degree of postoperative regret. RESULTS:Of 3638 patients, 2,530 (70%) underwent elective and 1108 (30%) underwent urgent/emergent colectomy. Overall, 381 (10.5%) patients reported regret, with higher rates among the urgent/emergent setting compared with the elective cohort (13.0% vs 9.4%; p < 0.001). In the elective cohort, regret was associated with length of stay >7 days (OR, 2.32; 95% CI, 1.06-5.07), postoperative complication (OR, 1.95; 95% CI, 1.36-2.79), and readmission (OR, 1.90; 95% CI, 1.22-2.95). Elective colectomies for cancer/adenoma/polyp were associated with lower odds of regret (OR, 0.68; 95% CI, 0.50-0.91). In the urgent/emergent cohort, regret was associated with female sex (OR, 1.69; 95% CI, 1.15-2.50) and nonhome discharge destination (OR, 1.61; 95% CI, 0.04-1.03).LIMITATIONS: Hospitals used different sampling strategies, limiting our ability to calculate a true response rate and characterize nonresponders. CONCLUSIONS:One in 10 patients reported regret after colectomy with higher rates in those undergoing urgent/ emergent colectomy. Factors associated with regret were different between surgical settings. Efforts are needed to mitigate patients' risk of regret with individualized discussions contingent on surgical settings to better align expectations and outcomes.

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Section: Discussionmentioning

confidence: 61%

Decisional Regret Among Patients Undergoing Colectomy

Janes

Lussiez

Anderson

et al. 2022

Diseases of the Colon &Amp; Rectum

Self Cite

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“…The study shows that aspects like personal experience are given considerable weight compared to patient participation, which remains underrepresented. [59] Inadequate medical communication and nonexplanation of post-operative outcomes are further barriers to patient participation for decision-making and therapy adherence. [63,64] Mutual willingness to engage in dialogue and communication of available options are considered to be facilitators.…”

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confidence: 99%

“…As barriers, this relates foremost to the workload and time pressure to which medical professionals are subject [54,59,61,64,65] and, in addition, aspects such as heterogeneity of involved physicians[65], staff rotation, diverging treatment strategies[64,65] and lack of integration of SDM in clinical practices [53,59,61].…”

Section: Insert Table 3 About Herementioning

confidence: 99%

Patients’ and healthcare professionals’ perceived facilitators and barriers for shared decision-making for frail and elderly patients in perioperative care: A scoping review

Vogel

Guinemer

Fürstenau

2022

Preprint

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BACKGROUND: Shared decision-making (SDM) in perioperative care, an organizational approach to instituting sharing of information and decision-making around surgery, aims at enabling patient-centric treatment and alignment of care to individual patient needs. Frail and elderly patients suffering from multiple health conditions and increased surgical vulnerability require individualized healthcare and may benefit. However, little is known about the facilitators and barriers to implementing SDM in perioperative care for the specific needs of frail and elderly patients. Our objective is twofold: First, we aim at collecting and communicating facilitators and barriers. Second, we aim at collecting conceptual approaches and methods employed in determining and analyzing these facilitators and barriers. METHODS: The search strategy focused on peer-reviewed studies. We employed a taxonomy which is based on the SPIDER framework and added the items general article information, stakeholder, barriers/facilitators, category, subcategory, and setting/contextual information. This taxonomy is based on preceding studies. The scoping review is reported under the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews. Based on the databases MEDLINE, Embase, CINAHL, and Web of Science, we identified and reviewed 13 original studies. RESULTS: The major result is that patients want to be informed on their medical condition and procedures. The results further indicate that patients prefer sharing decisions over taking decisions on their own or physician induced decision-making. Communication barriers and asymmetric power relationships between patients and clinical healthcare professionals are barriers to SDM. Regarding the methodological approaches, the evaluation demonstrates that the selected articles are primarily concerned with the collection of determinants that enable or impede the implementation of SDM. These approaches lack employing a distinct theoretical framework for explaining these determinants. Second, the selected studies mainly used surveys and interviews, ethnographic studies are absent. CONCLUSION: Diverging findings perceived by patients or clinical healthcare professionals were identified. These imply that SDM research related to elderly and frail patients should become more encompassing by employing research that incorporates theory-based qualitative analysis, and ethnographic studies of SDM consultations for understanding practices by patients and clinical healthcare professionals. Ethnographic studies are particularly relevant as these were not conducted. REGISTRATION: https://osf.io/8fjnb/

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“…Surgeons should consider themselves just as critical as palliative medicine specialists in contributing to the workforce of providers who conduct high-quality serious illness conversations. In addition to the widely reported benefits of having discussions about functional, diagnostic, and therapeutic uncertainties, the work in normalizing serious illness conversations in surgery must also factor the importance of initiating these conversations earlier in the course of disease to derive the greatest benefit (11)(12)(13). This contribution calls on surgeons of every discipline to ask themselves how they feel to address uncertainty in routine discussions with patients and their family members.…”

Section: Introductionmentioning

confidence: 99%