Are Surgery Risks Adequately Explained To Older Patients?

One of the most important elements of the physician-patient relationship is informed consent. Informed consent involves an agreement, between a patient and treating physician, whereby the patient allows their treating physician to undertake specific treatment. This agreement gives the patient certain rights. A patient has the right to decide what happens to his or her body. A doctor may have an opinion about what the patient should choose to do, but the ultimate decision belongs solely to the patient. A doctor may not pressure a patient into a decision. In order for the patient to properly given consent, a medical professional must provide the patient with enough information to make an educated decision. This means the patient should be well aware of the risks and benefits of the procedure. 

However, the current standards for discussing the risks and benefits of surgical procedures may not be adequate in an older population. Studies have shown that physicians often do not ask elderly patients questions about their health and life goals. Additionally, elderly patients report that the pre-surgical conversations that are being held are in no way tailored to their specific needs. Older patients face a much higher risk of complications from many procedures. Additionally, older patients, often have different priorities than younger ones. In many cases, they value their ability to live independently and spend quality time with loved ones more than they value longevity.

Rather than engaging in a nuanced discussion of how the patient’s life and independence may be affected by the procedure, surgeons tend to simply state the physical problem, how surgery is meant to correct it and what complications are possible, citing references to scientific studies. This can often lead to unsatisfactory outcomes, especially in cases when patients are facing an incredibly difficult or debilitating recovery period, something that elderly surgical patients often do face.

However, this summer The American College of Surgeons (ACS) introduced the Geriatric Surgery Verification (GSV) Program, which presents 30 new surgical standards designed to improve surgical care and outcomes for older adults. The standards provide “a framework for hospitals to take an interdisciplinary approach to continuously optimize surgical care for older adults.”

The GSV Program will allow older patients the opportunity to discuss their health goals and goals for the procedure, as well as their expectations for their recovery and their quality of life after surgery. The standards state that surgeons should review their advance directives or offer patients without these documents the chance to complete them. Also, if a stay in intensive care is expected after surgery, that should be made clear, along with the patient’s instructions on interventions such as feeding tubes, dialysis, blood transfusions, cardiopulmonary resuscitation, and mechanical ventilation.

The GSV Program standards are publicly available on the ACS website for hospitals to review before the national enrollment process opens, in late fall 2019 during the ACS Clinical Congress.