ArticleAnnals of surgery2018
Barriers to Goal-concordant Care for Older Patients With Acute Surgical Illness: Communication Patterns Extrinsic to Decision Aids.
Article in Annals of surgery, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
19 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Pooled it
- Pooled it
- Exploring Pathways to Optimise Care in malignant bowel obstruction (EPOC): A realist review of shared decision-making with people with advanced cancer and severe symptoms.Palliative medicine · 2026Review
- Reliability of a rating rubric to assess quality of preoperative goals of care notes.American journal of surgery · 2026Article
- "Do Everything" versus realistic surgical interventions: navigating the road to shared decision-making in trauma surgery.Trauma surgery & acute care open · 2026Review
- Barriers and Strategies to Effective Serious Illness Communication for Patients with End-Stage Liver Disease in the Intensive Care Setting.Journal of intensive care medicine · 2026Review
- A Scoping Review on Goals of Care Discussions in Surgery: How Are We Doing and How Can We Do Better?World journal of surgery · 2025Article
- [Oncological operation reports: minimum requirements, legal aspects and future developments].Chirurgie (Heidelberg, Germany) · 2025Review
- The Struggle Continues: Improving Outcomes for Surrogate Decision-Makers after the ICU.American journal of respiratory and critical care medicine · 2025Article
- Psychometric validation of the informed consent assessment scale using item response theory and factor analysis.Frontiers in medicine · 2025Article
- Better Conversations for Better Informed Consent: Talking with Surgical Patients.The Hastings Center report · 2024Article
- An Update on Palliative Care in Neurocritical Care: Providing Goal‑Concordant Care in the Face of Prognostic Uncertainty.Current treatment options in neurology · 2023Article
- Top Ten Tips Palliative Care Clinicians Should Know About Trauma and Emergency Surgery.Journal of palliative medicine · 2021Article
- Factors Associated With Decision Regret Among Patients With Diverticulitis in the Elective Setting.The Journal of surgical research · 2021Article
- Older Adult Perspectives on Medical Decision Making and Emergency General Surgery: "It had to be Done."Journal of pain and symptom management · 2021Article
- Guidelines for Perioperative Care for Emergency Laparotomy Enhanced Recovery After Surgery (ERAS) Society Recommendations: Part 1-Preoperative: Diagnosis, Rapid Assessment and Optimization.World journal of surgery · 2021Article
- Shared decision making in surgery: A scoping review of the literature.Health expectations : an international journal of public participation in health care and health policy · 2020Article
- "Hopes and wishes": Goals of high-need, high-cost older patients and their caregivers.Patient education and counseling · 2020Article
- Prioritizing Communication in the Provision of Palliative Care for the Trauma Patient.Current trauma reports · 2020Review
Corrections and comments
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Authors and funding
9 authors.
Funding
Abstract
objectiveWe sought to characterize patterns of communication extrinsic to a decision aid that may impede goal-concordant care.
backgroundDecision aids are designed to facilitate difficult clinical decisions by providing better treatment information. However, these interventions may not be sufficient to effectively reveal patient values and promote preference-aligned decisions for seriously ill, older adults.
methodsWe conducted a secondary analysis of 31 decision-making conversations between surgeons and frail, older inpatients with acute surgical problems at a single tertiary care hospital. Conversations occurred before and after surgeons were trained to use a decision aid. We used directed qualitative content analysis to characterize patterns within 3 communication elements: disclosure of prognosis, elicitation of patient preferences, and integration of preferences into a treatment recommendation.
resultsFirst, surgeons missed an opportunity to break bad news. By focusing on the acute surgical problem and need to make a treatment decision, surgeons failed to expose the life-limiting nature of the patient's illness. Second, surgeons asked patients to express preference for a specific treatment without gaining knowledge about the patient's priorities or exploring how patients might value specific health states or disabilities. Third, many surgeons struggled to integrate patients' goals and values to make a treatment recommendation. Instead, they presented options and noted, "It's your decision."
conclusionsA decision aid alone may be insufficient to facilitate a decision that is truly shared. Attention to elements beyond provision of treatment information has the potential to improve communication and promote goal-concordant care for seriously ill older patients.
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Registered trials
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