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Surgical Decisions for High-Risk Patients Needs Overhaul

New model includes multidisciplinary team and information about less invasive options

FRIDAY, April 11, 2014 (HealthDay News) -- High-risk elderly patients facing decisions about major surgery may not always be presented with all treatment options, including less invasive choices, according to a perspective piece published in the April 10 issue of the New England Journal of Medicine.

Laurent G. Glance, M.D., from the University of Rochester in New York, and colleagues write that a cultural shift in shared decision making for surgical care is necessary, as surgeons may be biased toward aggressive treatment approaches or may not know the patient well enough to appreciate their life circumstances, values, or preferences.

The authors argue that patients need to be given the choice among all appropriate treatment options, including no treatment. Additionally, they need to understand the potential benefits of each option, the likelihood of a good outcome, and the risk of complications. A multidisciplinary group of experts, including possibly a primary care physician and nonphysicians (possibly social workers or physical therapists), may be needed to evaluate options. A multidisciplinary approach may also improve care quality and reduce complications or rehospitalizations.

"For patients at high risk for adverse events after surgery, or in cases in which the balance of risks and benefits may be equivocal, the traditional surgery model may fall far short of the ideal," the authors write.

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