Multidisciplinary Surgical Decision Making for Older, High Risk Patients

项目摘要 目前的手术同意做法对接受高风险手术的老年人来说是不够的。一 真正了解手术的长期健康并发症是很难实现的， 谈话针对这一问题，我院实施了多学科术前决策 2016年的会议。为了创造一个更加以病人为中心的讨论，我们开始在这些会议中包括病人 2022年1月。我们的试点数据使我们得出结论，多学科讨论的高风险 老年人的手术应该成为在这些复杂情况下做出决策的范例。这 GEMSSTAR提案旨在了解将老年患者和护理人员纳入 一个多学科的术前讨论，并使用一个共同的决策框架，以优化 会议结构。 这项建议的目的是： 1)在多学科高风险手术决策过程中确定医疗保健提供者的沟通实践- 进行促进或限制患者/护理人员参与的讨论。 2)确定老年人和照顾者参与多学科小组讨论的影响， 他们的高风险手术决定 3)确定关键组件，以确保医疗保健提供者参与多学科高风险 与患者讨论。 在丹佛VA HSR&D的支持和专业知识的帮助下，我们将能够阐明这些优势， 讨论和完善多学科手术决策会议的结构模型。 该项目的成功完成将使琼斯博士成为外科决策专家， 申请退伍军人事务部职业发展奖，并进一步传播这种护理模式。

Project Summary Current surgical consent practices are inadequate for older adults undergoing high-risk procedures. A true understanding of the long-term health complications of an operation is difficult to achieve in one conversation. To address this issue, our institution implemented a multidisciplinary preoperative decision-making conference in 2016. To create a more patient-centric discussion, we started including patients in these meetings in January 2022. Our pilot data has led us to the conclusion that multidisciplinary discussions for high-risk surgeries in older adults should be the paradigm for decision-making in these complex situations. This GEMSSTAR proposal is designed to understand the impact of including older adult patients and caregiver(s) in a multidisciplinary preoperative discussion and to use a shared decision-making framework to optimize the meeting structure. The aims of this proposal are to: 1)Identify communication practices of healthcare providers during multidisciplinary high-risk surgical decision- making discussions that facilitate or limit patient/caregiver engagement. 2)Determine the impact of older adult and caregiver(s) participation in multidisciplinary group discussions on their high-risk surgical decision 3)Identify critical components to ensure healthcare provider engagement in multidisciplinary high-risk discussions with patients. With the support and expertise of the Denver VA HSR&D, we will be able to clarify the benefits of these discussions and refine the structure model for multidisciplinary surgical decision-making conferences. Successful completion of this project will allow Dr Jones to become an expert in surgical decision-making to apply for a VA Career Development Award and further disseminate this model of care.