ArticleSurgery2021
High-risk surgery among older adults: Not-quite shared decision-making.
Article in Surgery, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
17 citing papers in PubMed, 34 citations in OpenAlex.
- "It's Either Have Surgery or Die": How Patients Perceive the Choice to Undergo High-Risk Abdominal Surgery for Cancer.Annals of surgery open : perspectives of surgical history, education, and clinical approaches · 2026Article
- The Impact of Initiating the Older Adult Surgical Inpatient Service on the Quantity and Quality of Goals of Patient Care Documentation.Australasian journal on ageing · 2026Article
- Review
- Challenges, care gaps, and coping mechanisms in patients with advanced cancer and their caregivers following palliative gastrointestinal surgery.Palliative care and social practice · 2026Article
- Shared decision-making in urinary reconstruction among radical cystectomy patients: a thematic analysis of patient and provider perspectives in China.BMC cancer · 2025Article
- Clinical and economic burden among older adults with acromegaly in the United States.Journal of comparative effectiveness research · 2025Article
- A Qualitative Study on Surgeon Perceptions of Risk Calculators in Emergency General Surgery.Annals of surgery open : perspectives of surgical history, education, and clinical approaches · 2025Article
- Frailty and Long-Term Health Care Utilization After Elective General and Vascular Surgery.JAMA surgery · 2025Observational
- Navigating the Surgical Pathway for Frail, Older Adults Undergoing Colorectal Surgery.Clinics in colon and rectal surgery · 2025Review
- Is Everyone Beating Around the Bush?: A Qualitative Study Examining the Status of Shared Decision-Making Between Veterans Affairs Providers and Surgical Patients in the ICU.Annals of surgery open : perspectives of surgical history, education, and clinical approaches · 2024Article
- Opportunities for shared decision-making about major surgery with high-risk patients: a multi-method qualitative study.British journal of anaesthesia · 2023Article
- Patients' and healthcare professionals' perceived facilitators and barriers for shared decision-making for frail and elderly patients in perioperative care: a scoping review.BMC health services research · 2023Article
- Managing Chronic Limb-Threatening Ischaemia in Patients at the Extremes of Older Age Requires a Patient-Focused Approach.World journal of surgery · 2022Article
- Recurrent Diverticulitis: Where Uncomplicated Is Complicated.Annals of surgery open : perspectives of surgical history, education, and clinical approaches · 2022Article
- Surgeons' Perspective of Decision Making in Recurrent Diverticulitis: A Qualitative Analysis.Annals of surgery open : perspectives of surgical history, education, and clinical approaches · 2022Article
- Exploring Key Elements of Surgical Shared Decision Making for Providers and Older Adults.MDM policy & practiceArticle
- Shared Decision Making and Its Association with Antiviral Therapy Adherence in Patients with Chronic Hepatitis B: Single-Center Cross-Sectional Analysis.MDM policy & practiceArticle
Corrections and comments
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Authors and funding
7 authors at 1 institution in 1 country.
Funding
Abstract
backgroundShared decision-making is critical to optimal patient-centered care. For elective operations, when there is sufficient time for deliberate discussion, little is known about how surgeons navigate decision-making and how surgeons align care with patient preferences. In this context, we sought to explore surgeons' approaches to decision-making for adults ≥65 years at high-risk of postoperative complications or death.
methodsWe conducted semistructured in-depth interviews with 46 practicing surgeons across Michigan. Transcripts were iteratively analyzed through steps informed by inductive thematic analysis.
resultsFour major themes emerged characterizing how surgeons approach high-risk surgical decision-making for older adults: (1) risk assessment was defined as the process used by surgeons to identify and analyze factors that may negatively impact outcome; (2) expectations and goals described the process of surgeons engaging with patients and families to discuss potential outcomes and desired objectives; (3) external and internal motivating factors outlined extrinsic dynamics (eg, quality metrics, referrals) and intrinsic drivers (eg, surgeons' personal experiences) that influenced high-risk decision-making; and (4) decision-making approaches and challenges encompassed the roles of patients and surgeons and obstacles to engaging in a true shared decision-making process.
conclusionAlthough shared decision-making is strongly recommended, we found that surgeons who perform high-risk operations among older adults predominantly focused on assessing risk and setting expectations with patients and families rather than inviting them to actively participate in the decision-making process. Surgeons also reported influences on decision-making from quality metrics, referrals, and personal experiences. Patient involvement, however, was seldom discussed suggesting that surgeons may not be engaging in true shared decision-making when benefits should be weighed against a high likelihood of harm.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.