Training surgeons in shared decision-making with cancer patients aged 65 years and older: a pilot study

Abstract

Noralie H Geessink,1,2 Yvonne Schoon,1,2 Marcel GM Olde Rikkert,1 Harry van Goor3 1Department of Geriatric Medicine, 2Radboud Institute for Health Sciences, 3Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands Objective: Treatment decision-making in older patients with colorectal (CRC) or pancreatic cancer (PC) needs improvement. We introduced the EASYcare in Geriatric Onco-surgery (EASY‑GO) intervention to optimize the shared decision-making (SDM) process among these patients.Methods: The EASY-GO intervention comprised a working method with geriatric assessment and SDM training for surgeons. A non-equivalent control group design was used. Newly diagnosed CRC/PC patients aged ≥65 years were included. Primary patient-reported experiences were the quality of SDM (SDM-Q-9, range 0–100), involvement in decision-making (Visual Analog Scale for Involvement in the decision-making process [range 0–10]), satisfaction about decision-making (Visual Analog Scale for Satisfaction concerning the decision-making process [range 0–10]), and decisional regret (Decisional Regret Scale [DRS], range 0–100). Only for DRS, lower scores are better.Results: A total of 71.4% of the involved consultants and 42.9% of the involved residents participated in the EASY-GO training. Only 4 trained surgeons consulted patients both before (n=19) and after (n=19) training and were consequently included in the analyses. All patient-reported experience measures showed a consistent but non-significant change in the direction of improved decision-making after training. According to surgeons, decisions were significantly more often made together with the patient after training (before, 38.9% vs after, 73.7%, p=0.04). Sub-analyses per diagnosis showed that patient experiences among older PC patients consistent and clinically relevant changed in the direction of improved decision-making after training (SDM-Q-9 +13.4 [95% CI −7.9; 34.6], VAS-I +0.27 [95% CI −1.1; 1.6], VAS-S +0.88 [95% CI −0.5; 2.2], DRS −10.3 [95% CI −27.8; 7.1]).Conclusion: This pilot study strengthens the practical potential of the intervention’s concept among older surgical cancer patients. Keywords: shared decision making, training program, surgeons, elderly, colorectal cancer, pancreatic cancer

Keywords

• - Shared decision-making - Training program - Surgeons - Elderly - Colorectal cancer - Pancreatic cancer