Aligning Surgical Decisions with Older Adults' Goals to Improve Patient-Centered Care

Older adults facing multiple chronic conditions often encounter significant challenges when making decisions about surgery. These difficulties stem from the uncertainty surrounding the potential benefits of procedures and the increased risks involved, which can vary greatly depending on individual health goals. Recognizing the importance of personalized care, a recent research letter published in the Journal of the American Geriatrics Society introduces a novel decision-making tool designed to ensure that surgical interventions align with what matters most to each patient.

Traditional decision aids mainly focus on providing information about various treatment options, but they often fail to address whether these options meet the specific health outcomes desired by the patient. As Dr. Mary E. Tinetti from Yale University explains, this gap highlights the need for tools that facilitate discussions about patient-centered goals beyond merely 'fixing' a clinical problem.

The new Patient Priorities-Aligned Intervention Decisions tool emphasizes meaningful conversations between patients and clinicians. It begins by categorizing procedure-related goals into four broad areas: feeling better, living longer, preventing disability, and obtaining a diagnosis. The tool guides patients through identifying realistic health outcome goals, highlights key symptoms or impairments they wish to address, and encourages them to express concerns about proceeding or skipping the procedure.

Feedback from older adults who tested the tool indicated that they often prioritized goals such as being able to walk a mile or independently bathing and dressing. Many participants found the questions relevant, noting that the tool helped foster discussions about fears, expectations, and desired outcomes—factors that often influence surgical decisions.

Integrating this approach into clinical practice promotes care that is more aligned with the unique priorities of older adults. It supports the move toward age-friendly, patient-centered healthcare, aligning with recent guidelines from the Centers for Medicare & Medicaid Services.

Rooted in the principles of Patient Priorities Care, this tool has demonstrated effectiveness in reducing treatment burdens and enhancing the alignment of care with patient preferences, particularly for those managing chronic conditions. Dr. Tinetti emphasizes that efforts are underway to expand such conversations system-wide and even influence healthcare policies related to quality measurement and payment models. The goal is to foster a healthcare environment where respecting individual goals leads to less unwanted treatment and more beneficial, desired care.

Co-author Dr. Rachel Lampert from Yale University highlights that shifting decision-making frameworks towards patient priorities not only improves individual outcomes but also has the potential to optimize resource utilization and overall healthcare quality.

Source: https://medicalxpress.com/news/2025-08-uncertainty-aligning-surgical-decisions-older.html