Multidisciplinary Surgical Decision Making for Older, High Risk Patients

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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.