Protocol paper for SMART OPS: Shared decision-making Multidisciplinary Approach - a Randomised controlled Trial in...

Area of Science:

• Geriatric Surgery
• Patient-Centered Care
• Health Services Research

Background:

• The Australian surgical population is aging, with increased frailty and comorbidities.
• Shared decision-making (SDM) is crucial for value-based healthcare in high-risk surgery.
• While immediate benefits of SDM are known, long-term outcomes and costs need investigation.

Purpose of the Study:

• To propose and evaluate a novel multidisciplinary SDM model for perioperative high-risk surgical patients.
• To assess the impact of SDM on decisional conflict, patient-centered outcomes, and healthcare resource utilization.

Main Methods:

• A prospective randomized controlled trial comparing standard care with a multidisciplinary SDM consultation.
• Participants in general, vascular, and head and neck surgery were randomized.
• Primary outcome: decisional conflict pre-surgery; secondary outcomes: longitudinal conflict, patient-centered metrics, morbidity, mortality, and healthcare resource use up to 1 year.

Main Results:

• Primary outcome data on decisional conflict is currently being collected.
• Secondary outcome data on treatment choice, longitudinal decisional conflict, patient-centered outcomes, and healthcare resource use are also being gathered.
• Analysis of morbidity and mortality will be conducted.

Conclusions:

• The study aims to provide evidence on the effectiveness of a multidisciplinary SDM model in high-risk surgical patients.
• Findings will elucidate the impact of SDM on patient decision-making, quality of life, and health service costs.
• This research will inform best practices for perioperative care in an aging and complex surgical population.