Needed: Better Decision Making for the Sickest Patients

By Jane Farrell

A sick, elderly patient who is considering risky surgery needs comprehensive help in the decision process, according to an analytical piece published in the New England Journal of Medicine.

Laurent G. Glance, M.D, professor and vice-chair for research in the Department of Anesthesiology at the University of Rochester School of Medicine and Dentistry, said that a team approach would lead to better care that’s in accordance with the patient’s values.

Glance also advocates a thorough presentation of options, including medical treatment, less serious surgeries, or watchful waiting to see if a condition worsens.

 “Evaluating treatment options, formulating recommendations and articulating the benefits and risks to patients comprehensively require more than a well-informed or experienced surgeon,” Glance wrote.

Glance reported that one-third of elderly Americans have surgery in the last 12 months of their lives, most within the last month. But, he said, three-quarters of seriously ill patients say they would not choose surgery if they knew they are likely to have severe complications afterward.

The best way to remedy this problem, Glance said, is consultation with a team of providers, including physicians, nurses and social workers. That helps patients better understand the benefits and risks of each option and helps them make the best possible decision.

Currently, such teamwork occurs mostly by chance. In the future, Glance wrote, multidisciplinary teams could meet regularly – in person or virtually – to discuss high-risk cases.