Outcomes following the introduction of an interdisciplinary shared decision-making clinic for older patients with colorectal cancer.

Abstract

Aim: Colorectal cancer (CRC) incidence is highest in older patients, who also have high rates of concurrent multimorbidity and frailty. Shared decision making is important when deciding treatment. The aim of this study was to compare outcomes before and after introduction of a shared decision-making (SDM) pathway, which includes an anaesthetist and geriatrician, for older patients with CRC at Waikato Hospital.

Method: Retrospective review of patients over 70 years of age considered for surgical resection was performed before (2018) and after (2020) introduction of the SDM pathway. Primary outcome was days alive out of hospital (DAOH) at 12 months. Data were collected on demographics, disease factors, specialist assessments, frailty and cognitive function, treatment, deviation from colorectal multi-disciplinary meeting (MDM) recommendation and outcomes.

Results: In total, 169 patients were included. There were 103 males and the median age was 79 years (range 70-95). After the introduction of the SDM clinic, more patients underwent non-operative management (16.1% vs 4.9%, p=0.02) and had management that deviated from MDM recommendation (18.4% vs 4.9%, p=0.01). DAOH was marginally higher after introduction of the SDM clinic (358 vs 352, p=0.02). There was no difference in survival.

Conclusion: An interdisciplinary SDM clinic for older patients with CRC is feasible in a tertiary hospital in New Zealand and may increase non-operative management and DAOH without impacting overall survival.