Multidisciplinary Surgical Decision Making for Older, High Risk Patients

项目摘要 目前的手术同意做法不适合正在接受高风险手术的老年人。一个 真正了解手术的长期健康并发症是很难一蹴而就的 交谈。为了解决这个问题，我们的机构实施了多学科的术前决策。 会议将于2016年举行。为了创造一个更以患者为中心的讨论，我们开始让患者参加这些会议 在2022年1月。我们的试点数据使我们得出结论，针对高风险的多学科讨论 在这些复杂的情况下，老年人的手术应该成为决策的范例。这 GEMSSTAR提案旨在了解将老年患者和照顾者(S)纳入 多学科的术前讨论，并使用共享决策框架来优化 会议结构。 这项建议的目的是： 1)确定医疗保健提供者在多学科高风险手术决策期间的沟通做法- 进行讨论，以促进或限制患者/护理者的接触。 2)确定老年人和照顾者(S)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 与病人的讨论。 在丹佛退伍军人事务部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 讨论并提炼多学科外科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方面的专家 申请退伍军人职业发展奖，并进一步推广这种护理模式。

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.