Ethical considerations and the role of shared decision making in the vascular care of older adults

Vascular surgeons are often responsible for navigating treatment decisions when caring for older adults. Care for these patients is informed by the surgeon’s assessment of the patient’s decision-making capacity, use of advance care planning, and understanding of futility. Having difficult conversations with patients and their families is supported by strategies that promote empathic communication and shared decision making with older adults with serious illness due to, and associated with, vascular disease. These strategies include avoiding the cognitive trap, using heads-up and headline statements, best case and worst case to manage uncertainty, and better conversations to provide informed consent.