High-risk surgery among older adults: Not-quite shared decision-making
| Autor: | Michaela C. Bamdad, Mary E. Byrnes, Pasithorn A. Suwanabol, Ana C. De Roo, Samantha J. Rivard, Crystal Ann Vitous, Sara M. Jafri |
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| Rok vydání: | 2021 |
| Předmět: |
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Michigan medicine.medical_specialty media_common.quotation_subject Context (language use) 030230 surgery Article 03 medical and health sciences 0302 clinical medicine Humans Medicine Quality (business) High risk surgery Referral and Consultation Qualitative Research Aged media_common Surgeons business.industry Patient Preference Middle Aged Harm Elective Surgical Procedures 030220 oncology & carcinogenesis Family medicine Sufficient time Female Surgery Personal experience Patient Participation Thematic analysis business Risk assessment Decision Making Shared |
| Zdroj: | Surgery |
| ISSN: | 0039-6060 |
| DOI: | 10.1016/j.surg.2021.02.005 |
| Popis: | Background Shared decision-making is critical to optimal patient-centered care. For elective operations, when there is sufficient time for deliberate discussion, little is known about how surgeons navigate decision-making and how surgeons align care with patient preferences. In this context, we sought to explore surgeons’ approaches to decision-making for adults ≥65 years at high-risk of postoperative complications or death. Methods We conducted semistructured in-depth interviews with 46 practicing surgeons across Michigan. Transcripts were iteratively analyzed through steps informed by inductive thematic analysis. Results Four major themes emerged characterizing how surgeons approach high-risk surgical decision-making for older adults: (1) risk assessment was defined as the process used by surgeons to identify and analyze factors that may negatively impact outcome; (2) expectations and goals described the process of surgeons engaging with patients and families to discuss potential outcomes and desired objectives; (3) external and internal motivating factors outlined extrinsic dynamics (eg, quality metrics, referrals) and intrinsic drivers (eg, surgeons’ personal experiences) that influenced high-risk decision-making; and (4) decision-making approaches and challenges encompassed the roles of patients and surgeons and obstacles to engaging in a true shared decision-making process. Conclusion Although shared decision-making is strongly recommended, we found that surgeons who perform high-risk operations among older adults predominantly focused on assessing risk and setting expectations with patients and families rather than inviting them to actively participate in the decision-making process. Surgeons also reported influences on decision-making from quality metrics, referrals, and personal experiences. Patient involvement, however, was seldom discussed suggesting that surgeons may not be engaging in true shared decision-making when benefits should be weighed against a high likelihood of harm. |
| Databáze: | OpenAIRE |
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