Unique Challenges of Shared Decision-Making in Colorectal Surgery for the Elderly Patient.

Abstract

Older adults require disproportionately more operations and suffer more complications than their younger counterparts, making a thoughtful approach to shared decision-making imperative. This article reviews key considerations in the decision to pursue operative intervention for older adults. First, we explore the "Fix It" model and the importance of acknowledging trade-offs, with a specific focus on quality of life. This is followed by a discussion of how surgical recovery affects physical function, bowel function, and cognition. We describe strategies for shared decision-making in the older population, specifically eliciting patient preferences for overall health goals, establishing the goals of surgery, discussing advanced directives, and engaging caregivers. We anticipate these key content areas will provide surgeons with important insights with which to approach surgical decision-making for this vulnerable patient group.