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Updated: Mar 7, 2026

Oral Health Assessment by Lay Personnel for Older Adults
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Defining Surgical Shared Decision-Making for Older Adults Using the RAND/UCLA Appropriateness Method: A Consensus

Gabriela Poles1, Alexis Zimmer2, Janet Tran3

  • 1Department of Surgery, University of Rochester, Rochester, New York.

JAMA Network Open
|March 6, 2026
PubMed
Summary
This summary is machine-generated.

This study identified 43 valid and feasible components for shared decision-making (SDM) in older adults undergoing surgery. These components aim to improve preoperative communication and guide future interventions for better surgical care.

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Last Updated: Mar 7, 2026

Oral Health Assessment by Lay Personnel for Older Adults
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Area of Science:

  • Geriatric Medicine
  • Surgical Care
  • Health Services Research

Background:

  • Older adults face significant risks after major surgery, including functional decline and cognitive impairment.
  • Shared decision-making (SDM) is crucial for this population, but standardized guidelines are lacking.
  • Lack of defined SDM components hinders effective communication and care planning for elderly surgical patients.

Purpose of the Study:

  • To identify valid and feasible components for surgical shared decision-making (SDM) specifically tailored to older adults.
  • Establish a standardized framework for SDM in geriatric surgical care.
  • Inform the development of interventions to improve SDM for elderly patients.

Main Methods:

  • A 2-round modified Delphi process using the RAND/UCLA Appropriateness Method was employed.
  • Forty-one candidate SDM components were developed and rated by 11 panelists (clinicians and patient representatives).
  • Consensus was reached on validity and feasibility using a median score of 7.0 or greater with statistical agreement.

Main Results:

  • A total of 43 valid and feasible components for surgical SDM in older adults were identified.
  • Barriers to implementation included knowledge/skills deficits (33.5%), time constraints (26.2%), and cultural factors (18.3%).
  • Specific challenges involved assessing cognitive function and counseling on long-term outcomes.

Conclusions:

  • The identified 43 components offer a framework to enhance preoperative communication and quality measurement in geriatric surgery.
  • Addressing implementation barriers is crucial for successful integration of these SDM components.
  • This framework supports the development of interventions to improve SDM for older surgical patients.