• H J Schuijt, SmeeingD P JDPJDepartment of Surgery, Sint Antonius Hospital, Nieuwegein, the Netherlands., W R Verberne, GroenwoldR H HRHHDepartment of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands., van DeldenJ J MJJMDepartment of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Centre, Utrecht, the Netherlands., LeenenL P HLPHDepartment of Surgery, Utrecht University Medical Center, Utrecht, the Netherlands., and D van der Velde.
• Department of Surgery, Sint Antonius Hospital, Nieuwegein, the Netherlands; Department of Surgery, Utrecht University Medical Center, Utrecht, the Netherlands. Electronic address: h.schuijt@antoniusziekenhuis.nl.
• Injury. 2023 Oct 1; 54 (10): 110823110823.

AbstractGeriatric patients often present to the hospital in acute surgical settings. In these settings, shared decision-making as equal partners can be challenging. Surgeons should recognize that geriatric patients, and frail patients in particular, may sometimes benefit from de-escalation of care in a palliative setting rather than curative treatment. To provide more person-centred care, better strategies for improved shared decision-making need to be developed and implemented in clinical practice. A shift in thinking from a disease-oriented paradigm to a patient-goal-oriented paradigm is required to provide better person-centred care for older patients. We may greatly improve the collaboration with patients if we move parts of the decision-making process to the pre-acute phase. In the pre-acute phase appointing legal representatives, having goals of care conversations, and advance care planning can help give physicians an idea of what is important to the patient in acute settings. When making decisions as equal partners is not possible, a greater degree of physician responsibility may be appropriate. Physicians should tailor the "sharedness" of the decision-making process to the needs of the patient and their family.Copyright © 2023 Elsevier Ltd. All rights reserved.

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