Goals of Care

One in three high-risk patients choosing surgery will experience serious medical complications leading to long-term decline in health and quality of life. Often patients do not receive the information they need to make an informed decision about surgery. (1)

Shared decision making is a collaborative process between clinicians and patients, which aims to select the most suitable treatment option based on best available evidence and informed patient preferences. (1)

Screening Tools

  • Do you have an advanced care plan - a list of instructions to help guide a trusted person to make health care treatment decisions on your behalf if required?
  • Have you identified a substitute decision maker - someone you trust to make health care treatment decisions on your behalf if you are unable to do it yourself?
  • Is the patient at higher risk of perioperative complications? (e.g., advanced age, frailty, poor functional capacity, moderate/highly invasive surgery, multiple comorbidities)

Optimization is recommended for patients that answer No to question 1 or 2, or Yes to question 3.

Prehabilitation and Optimization Recommendations

Patient Education
  • Refer to online patient resources
Preoperative Goals of Care Discussion
  • Use the best-case scenario /  worst-case scenario framework (2)
Referral for Comprehensive Geriatric Assessment (CGA)
  • Consider preoperative assessment by Geriatrics to delineate risk

References

1. Centre for Perioperative Care. (n.d.). Shared decision making for clinicians. Retrieved October 21, 2024, from https://www.cpoc.org.uk/guidelines-resources-resources/shared-decision-making-clinicians

2. Kruser, J. M., Nabozny, M. J., Steffens, N. M., Brasel, K. J., Campbell, T. C., Gaines, M. E., & Schwarze, M. L. (2015). "Best Case/Worst Case": Qualitative Evaluation of a Novel Communication Tool for Difficult in-the-Moment Surgical Decisions. Journal of the American Geriatrics Society, 63(9), 1805–1811. https://doi.org/10.1111/jgs.13615

Surgical Prehabilitation Toolkit