Leveraging the Preoperative Clinic to Engage Older Patients in Shared Decision Making About Complex Surgery: An Illustrative Case.
The decision to pursue surgery is often complicated in older adults. A multidisciplinary, shared approach to decision-making may improve communication between patients and their providers and facilitate complex risk assessment. We describe a case of an older adult presenting for complex surgery in which the preoperative anesthesia clinic visit was used to facilitate involvement of the geriatrics service. This multidisciplinary approach allowed for re-evaluation and reiteration of risks and benefits, in-depth discussion of the patient's values and goals, and recommendations for care teams downstream in the patient's surgical pathway to ensure treatment consistent with patient goals and clinical recommendations.
From the *Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; †Department of Anesthesia, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts; ‡Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; §Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; and ∥Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts.
Sushila
S
Murthy
David Lerner
DL
Hepner
Zara
Z
Cooper
Houman
H
Javedan
Lauren Jan
LJ
Gleason
John H
JH
Chi
Angela Maria
AM
Bader
D000369:Aged, 80 and over; D000066491:Clinical Decision-Making / Q000379:methods*; D003657:Decision Making; D019299:Decompression, Surgical / Q000379:methods*; D006801:Humans; D007796:Laminectomy / Q000379:methods*; D008297:Male; D011300:Preoperative Care / Q000379:methods*