For many older patients, high-risk surgery can prolong their lives and/or improve their symptoms. However, for others, especially those with multiple chronic conditions, the decision to proceed with surgery can launch a care trajectory that leads to potentially unwanted outcomes. These include lower quality of life 1, more hospitalizations 2 , 3, potential suffering at the end of life 4 , 5, prolonged life support 6 or long-term care in a nursing home. Patients and their families may be blindsided by these downstream outcomes.
To mitigate this problem, we need to help older patients fully understand treatment options in the context of their values and preferences before they decide if high-risk surgery is right for them. Our preliminary research has shed light on how patient-surgeon communication patterns may make the decision-making process less effective. For example, we have found that surgeons often use oversimplified language to explain the technical aspects of surgery 7, and focus on specific risk disclosure as required by informed consent guidelines 8.
In our current studies, we are evaluating tools and processes to help close the gap between what surgeons know and patients understand. Those tools empower patients to ask questions about the broader implications of surgery, so they can provide not just informed consent, but communicate informed preferences.
1 Functional status after colon cancer surgery in elderly nursing home residents
2 Medicare post-discharge deaths and readmissions following elective surgery
3 Medical and surgical readmissions in the Veterans Health Administration: What proportion are related to the index hospitalization?
4 Failure-to-pursue rescue: Explaining excess mortality in elderly emergency general surgical patients with preexisting “do-not-resuscitate” orders
5 Palliative surgery for malignant bowel obstruction from carcinomatosis: A systematic review
6 The Society of Thoracic Surgeons 2008 cardiac surgery risk models: Part 1—coronary artery bypass grafting surgery
7 ‘And I think that we can fix it’: Mental models used in high-risk surgical decision making
8 It’s big surgery: Preoperative expressions of risk, responsibility, and commitment to treatment after high-risk operations.