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)
Essential communication regarding goals of care is essential for aligning surgical interventions with patient values, preferences, and clinical realities. 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 |
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| Preoperative Goals of Care Discussion |
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| Referral for Comprehensive Geriatric Assessment (CGA) |
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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
3. Taylor, L.J., Naboznym, M.J., Steffens, N.M., Tucholka, J.L., Brasel, K.J., Johnson, S.K., Zelenski, A., Rathouz, P.J., Zhao, Q., Kwekkeboom, K.L., Campbell, T.C., Schwarze, M.L. A Framework to Improve Surgeon Communication in High-Stakes Surgical Decisions: Best Case/Worst Case. JAMA Surg. 152(6), 531-538. https://doi.org/10.1001/jamasurg.2016.5674
