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

• Published in: Injury 2023-10, Vol.54 (10), p.110823-110823, Article 110823
• Main Authors: Schuijt, H.J., Smeeing, D.P.J., Verberne, W.R., Groenwold, R.H.H., van Delden, J.J.M., Leenen, L.P.H., van der Velde, D.
• Format: Article
• Language: English
• Subjects: Geriatric; Shared decision making; Trauma
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2023.05.054

•Surgical decision-making with geriatric patients is complex in acute surgical settings, and it is not always possible to make decisions as equals.•A shift in thinking from disease-oriented to a patient-goal oriented paradigm is required to provide better person-centred care for older patients.•Physicians must tailor the “sharedness” of decision-making to the needs of the patient and their family.•In this paper, we make recommendations to improve patient participation in decision-making in acute surgical settings. 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.