Perioperative Shared Decision-Making in the Older Adult Population

What is the problem?

The Australian population is ageing and expected to grow to 8.8 million older adults in Australia by 2057. Due to deterioration in health associated with ageing, a significant percentage of older adults undergo surgical procedures, a percentage that will only grow with evolving demographics. Older, frailer, more comorbid patients having surgical procedures have increased rates of prolonged recovery, postoperative complications, functional and cognitive decline, and loss of independence. Furthermore, research indicates that many of these surgeries are not in line with patient values, wishes or preferences, and are not leading to improved quality of life. It is increasingly apparent that undergoing futile surgery not only leads to physical and emotional burden upon the patient and their family, but increased practice variation and resource use, and by extrapolation, increased cost to the health care system. It is now acknowledged that this population of patients with surgical pathology nearing end of life should receive a different level of peri-operative care than the younger, healthier, lower risk surgical candidate.

About the research translation program

This project will pilot a new multidisciplinary shared decision-making model that involves: 

  1. An anaesthetic pre-consultation review of all available information regarding the patient’s health status, as well as the referral of the patient for any additional investigations and consultations before the appointment.
  2. A multidisciplinary meeting including the patient and their carer(s), the patient’s surgeon, anaesthetist and/or physician, as well as any other specialist deemed appropriate. Discussion will be guided by the BRAN structure from the Choosing Wisely UK campaign: 

a. What are the Benefits?
b. What are the Risks?
c. What are the Alternatives?
d. What happens if I do Nothing?

Following this discussion and the opportunity to follow up with any questions or queries prior to making a decision, patients can decide their own course of management. Discussion can then proceed to optimising the patient’s health and if surgery is proceeding, likely post-operative requirements (such as critical care support) and appropriate limits of care.

What will be the impact?

By providing a multidisciplinary perioperative shared decision-making model of care for patients considering surgery when nearing end of life, this project expects to improve the alignment of care with patient values and aims to improve decisional conflict around appropriate care. The model of care will also enable patients to express their values and desired care as they approach the end of their life with their caregivers and medical professionals, and to facilitate this through advanced care directives. 

For more information, contact Dr Pragya Ajitsaria at Pragya.Ajitsaria@health.nsw.gov.au