Satisfaction with Shared Decision Making and Decision Regret in Older Adults Undergoing Elective Colorectal Cancer Surgery

Introduction:

Involvement of Geriatricians in peri-operative assessment acknowledges the altered physiology of frail patients and helps to evaluate realistic outcomes as part of patient-centred shared decision making. This is with the aim of addressing modifiable risk factors, preventing complications, preparing for a realistic recovery and ensuring that treatment options are aligned to what is important to the patient.

There is data suggesting improved survival following geriatric peri-operative assessment but little analysis from the patient’s perspective; their thoughts about the shared decision-making process, regrets about having surgery and the impact it has had on their quality of life. This study aims to identify success of our peri-operative clinic based on patient-centred parameters.

Methods:

We identified 69 patients seen in our joint Anaesthestic and Geriatrician peri-operative assessment clinic before elective colorectal surgery. These patients were over the age of 65, had multiple co-morbidities and had their surgery between 2022-2024. Participants answered a standardised ‘Shared Decision-Making Questionnaire’  (SDM-Q-9) and ‘Decision Regret Scale’ over the phone.

Results:

45 patients were able to answer our questionnaires. 9 patients had died, 14 did not answer or declined and 1 was incorrectly identified. Ages ranged from 69 to 91, with the majority undergoing laparoscopic hemicolectomies. 100% of respondents felt the team helped them understand information regarding the operation, and 93% felt they made the decision jointly with the doctor. Though 6% felt that the operation did them harm, 100% agreed that it was the right decision and would go for the same choice if they chose again.

Conclusion:

Our study suggests that patients are very satisfied after having undergone surgery and had realistic expectations and goals from combined pre-operative assessment. The shared decision-making analysis is positive and demonstrates the importance of stressing ‘not having surgery’ as an option to patients. The subjective and retrospective nature of the study may limit results.