​Improved communication among surgeons, patients, and surrogates is necessary to ensure that elderly patients with serious illnesses receive the care that they want and avoid nonbeneficial emergency surgeries, according to the results of a study published in the December 2014 issue of Annals of Surgery. The researchers conducted a literature review and found that surgeon, patient, surrogate, and systemic factors, including time constraints, inadequate provider communication skills and training, uncertainty about prognosis, patient and surrogate anxiety and fear of inaction, and limitations in advance care planning, all lead to communication challenges and the possible performance of nonbeneficial surgery at the end of life. Although patient, surgeon, surrogate, and system factors all play a role, the researchers note that the type and intensity of surgical care that a patient receives is ultimately determined by a conversation, which often occurs during a moment of crisis. They caution that if these conversations fail to adequately address the burdens of treatment from the patient's perspective, care can default toward procedures that are overly intensive and potentially harmful to the patient. To minimize nonbeneficial treatment in this vulnerable population, the researchers recommend engaging in efforts to routinely address advance care planning before surgery, developing a structured approach to communicating with surgical patients with serious illness, providing improved palliative care training for practicing surgeons and trainees, and defining and measuring those surgical outcomes most relevant to older patients.

HRC Recommends: Open, effective communication is necessary to ensure that patients understand their options for care and receive care that is in line with their preferences. Risk managers may wish to investigate when and how healthcare providers communicate with older adults with serious illnesses regarding their condition, preferences, and treatment options. Risk managers should consult with legal counsel regarding matters involving advance directives and surrogate decision making.