N. Geessink1, Y. Schoon1, M. Olde Rikkert1, H. Van Goor1 1Radboud University Medical Center,Nijmegen, , Netherlands
Introduction: The number of cancer patients aged 65 years or older presenting for major abdominal surgery such as colorectal (CRC) and pancreatic cancer (PC) resections is rising. In frail older patients such procedures are highly associated with negative outcomes that threaten patients’ quality of life and functioning. Shared decision-making (SDM) and goal-oriented communication are widely recommended to improve treatment decision-making, deliver patient-preferred care, and improve overall outcomes. SDM is particularly applicable for surgical disorders such as rectal and pancreatic cancer where alternatives for a major operation are available. This study aimed to evaluate the EASYcare in Geriatric Onco-surgery (EASY-GO) intervention; an intervention designed to improve the SDM process in older CRC/PC patients.
Methods: The EASY-GO intervention comprised a training for surgeons in frailty assessment and SDM. After training, the EASY-GO working method was implemented by screening all patients on frailty and applying SDM. Adherence to the intervention was stimulated by training-on-the-job: surgeons received feedback post-consultation about the SDM process by a geriatric specialist. Consecutive patients aged ≥65 years with newly diagnosed CRC/PC were included at the surgical department of the Radboud university medical center, the Netherlands. Primary outcomes were patient-reported level of SDM (SDM-Q-9), satisfaction (VAS-S), involvement in decision-making (VAS-I), and decisional regret (DRS). Patient involvement was also rated by surgeons (VAS-I).
Results:Eleven surgeons were trained of whom 4 were eligible for complete evaluation since they consulted patients both before and after implementation in the study’s time frame (11 months). The 4 surgeons consulted 38 patients; 19 (15 PC,4 CRC) before and 19 (13 PC,6 CRC) after implementation. SDM-Q-9 scores increased with 3.9 2.6 (before 72.8
11.2,after 76.7
19.6;p=0.72), VAS-S with 0.8
1.3 (before 8.0
0.4,after 8.7
1.2;p=0.27), and VAS-I with 0.7
2.6 (before 6.9
2.8,after 7.6
1.6;p=0.72). DRS decreased with 7.4
17.9 (before 27.3
8.6,after 19.9
14.0;p=0.47). Surgeons’ VAS-I increased with 0.3
2.1 (before 7.4
1.5,after 7.6
0.7;p=0.47). SDM-Q-9 scores increased both in CRC (before 69.4
25.8,after 74.7
18.4;p=0.56) and PC patients (before 76.1
29.2,after 88.0
12.3;p=0.52).
Conclusions:Although statistical significance was not realized due to the small sample size, the consistent change in scores in the direction of improved decision-making strongly suggests a positive effect on SDM in this vulnerable onco-surgical patient group. The higher scores of PC patients may be explained by differences in number and duration of consultation and outcome perspective. The promising results suggest that clinically relevant improvements in patient-centeredness of this complex onco-surgery may be realized by ongoing training of surgeons in SDM. The results warrant further study on implementation of the EASY-GO intervention.