SP 9.08 Decision-Making Processes in Older Patients That Require, But Do Not Undergo, Emergency Laparotomy: A UK Multicentred Observational Study
Angeline Price, Stephen Knight, Susan Moug, Elf 2 Study GroupAbstract
Aims
A recent study (Elf 2) has shown that older adults (≥65 years) who require, but do not undergo, emergency laparotomy (the NoLap population) are very old and living with high levels of frailty and multimorbidity. We report on the second aim of this study: to explore the decision-making process behind the decision not to operate.
Methods
A prospective cohort study recruited 750 consecutive NoLap patients from 64 UK emergency surgical units (February - November 2021). Each NoLap patient had a surgical condition treatable by an emergency laparotomy as defined by The National Emergency Laparotomy Audit criteria. Shared decision-making (SDM) factors and multidisciplinary team (MDT) decision-making factors were explored. Free text answers underwent qualitative analysis.
Results
12.4% of NoLaps had an advanced decision to refuse treatment (ADRT). SDM (i.e. patient inclusion) was documented in 65.9% of NoLap cases (and assisted by family member in 34.4%). For those not involved (33.2%), 67.5% had family member consulted. However, in 9.0% of all the NoLap cases, neither the patient nor a family member was involved. MDT decision-making (2+ specialties) was reported in 66.2% of cases. The surgical team was involved in decision-making in almost all cases (99.9%), with 84.8% at consultant level and 73.5% in person. Medical team were the next highest specialty to be involved (33.0%) with geriatricians present in only 5%. Qualitative content analysis identified a broader range of factors warranting further exploration.
Conclusions
This study has demonstrated that multi-disciplinary, shared decision-making is possible in the complex, time-pressured emergency surgical setting.