Abstract
Background
Shared decision making (SDM) is supported by NICE, the Royal College of Surgeons, General Medical Council and protected through legislation. Evidence continues to be produced to support the use and implementation of SDM prior to elective surgery, however, little work appears to have been done in the emergency surgical setting. Decision making prior to emergency surgery can be complex, especially for older patients with increasing frailty whose risks from surgical intervention are higher than the general population. SDM in this context therefore has substantial importance. This is a planned sub-group analysis of a wider systematic review looking at the research into shared decision making for older or frail patients prior to a potential emergency surgical procedures.
Methods
This PROSPERO registered systematic review used PRIMSA guidelines to identify studies investigating SDM in the emergency surgical setting. The search was completed in November 2024. Papers investigating specifically frail or older patients were identified. A narrative synthesis of findings was subsequently completed.
Results
4513 abstracts underwent independent dual-screening, with 18 papers included in the initial review. Five papers specifically investigating older patients or patients with increasing frailty were identified within this sub-group analysis. A single paper looked at emergency surgery in general, with two papers looking at orthopaedic surgery and a further two looking at emergency general surgery. Most commonly, papers were framed from a patients’ perspective (three). One papers looked at the views of HCP and patients, with the final paper using only a HCP standpoint.
Conclusion
SDM in the context of emergency surgery for older patients or patients with increasing frailty remains under-researched. Further work to identify decision making priorities and improve SDM in this context is required.