Patient experiences and outcomes from a novel multidisciplinary preoperative shared decision-making clinic

We established a novel multidisciplinary preoperative clinic in 2023 to support elderly, frail and/or comorbid patients to make decisions about surgical treatment based on their goals and values. We aimed to examine the characteristics, postoperative outcomes and quality of shared decision-making (SDM) for patients seen in this clinic in its first year. We collected data regarding patient demographics, preoperative status and postoperative outcomes via review of the medical record, and conducted a telephone interview to assess quality of SDM via the CollaboRATE-5 and Decision Regret Scales. Seventy-one patients attended the clinic in 2023, with a median age of 78 years. Eighty-six percent of patients had an American Society of Anesthesiologists Physical Status classification of 3 or 4, and 69% were frail (Clinical Frailty Scale of 4 or more). Sixty-five percent of patients elected to proceed with surgery and 35% elected not to proceed. At follow-up, approximately 14 months after initial SDM review, 58% of patients had had surgery, with a median postoperative hospital length of stay of four days, and a median of 25.5 days alive and at home within 30 days of surgery. Telephone interview was successfully conducted with 24 patients. The CollaboRATE-5 top score was reported by 63% of respondents, and the median Decision Regret Scale score was 7.5 (interquartile range 0-25) suggesting a high quality of SDM. In the first year of its operation, our multidisciplinary preoperative clinic delivered high-quality SDM to a cohort of high-risk surgical patients, with those proceeding to surgery generally experiencing favourable postoperative outcomes.