Perspective; recommendations for improved patient participation in decision-making for geriatric patients in acute surgical settings.

Autor: Schuijt HJ; Department of Surgery, Sint Antonius Hospital, Nieuwegein, the Netherlands; Department of Surgery, Utrecht University Medical Center, Utrecht, the Netherlands. Electronic address: h.schuijt@antoniusziekenhuis.nl., Smeeing DPJ; Department of Surgery, Sint Antonius Hospital, Nieuwegein, the Netherlands., Verberne WR; Department of Internal Medicine, Utrecht University Medical Center, Utrecht, the Netherlands., Groenwold RHH; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands., van Delden JJM; Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Centre, Utrecht, the Netherlands., Leenen LPH; Department of Surgery, Utrecht University Medical Center, Utrecht, the Netherlands., van der Velde D; Department of Surgery, Sint Antonius Hospital, Nieuwegein, the Netherlands.
Jazyk: angličtina
Zdroj: Injury [Injury] 2023 Oct; Vol. 54 (10), pp. 110823. Date of Electronic Publication: 2023 May 19.
DOI: 10.1016/j.injury.2023.05.054
Abstrakt: Geriatric patients often present to the hospital in acute surgical settings. In these settings, shared decision-making as equal partners can be challenging. Surgeons should recognize that geriatric patients, and frail patients in particular, may sometimes benefit from de-escalation of care in a palliative setting rather than curative treatment. To provide more person-centred care, better strategies for improved shared decision-making need to be developed and implemented in clinical practice. A shift in thinking from a disease-oriented paradigm to a patient-goal-oriented paradigm is required to provide better person-centred care for older patients. We may greatly improve the collaboration with patients if we move parts of the decision-making process to the pre-acute phase. In the pre-acute phase appointing legal representatives, having goals of care conversations, and advance care planning can help give physicians an idea of what is important to the patient in acute settings. When making decisions as equal partners is not possible, a greater degree of physician responsibility may be appropriate. Physicians should tailor the "sharedness" of the decision-making process to the needs of the patient and their family.
Competing Interests: Declaration of Competing Interest All authors confirm that they have no conflict on interests. All authors do not have any financial and/or personal relationships with other people, or organisations, that could inappropriately influence (bias) their work.
(Copyright © 2023 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: