1879 On a knife's edge: role of a Clinical Nurse Specialist on balancing complex treatment decisions in acute surgery

Abstract

Abstract Introduction 1 in 4 older individuals having emergency general surgery live with frailty, are more likely to have a longer hospital stay, readmission rate, morbidity and mortality. This underscores the importance of individualised approaches to care through Shared Decision Making (SDM). We introduced SDM into our surgical liaison service aiming to measure effectiveness and patient outcomes. Methods Between October 2021 and September 2022, patients aged >70 years living with frailty admitted to the surgical unit were identified by an Older Persons Clinical Nurse Specialist (CNS). Involvement in treatment decisions was measured by using the patient and clinician SDM-Q9 questionnaire. Pre-admission as well as follow-up quality of life scores at 6 months using the EQ-5D-5L (0-100) as well as Decision Regret were obtained on subsets of patients. Results Of a total of 76 patients seen by the CNS, follow-up data were available for 61 patients, clinician and patient SM-Q9 were completed in 54 patients. Clinicians were 10% more likely to strongly or completely agree that they explained choice available, 16% more likely to feel they explained treatment options compared with patients. Patients were less likely to feel completely involved in decision making. However, they were more likely to agree they understood clinical information presented them. Low levels of decision regret were ascertained at follow up where 18 patients agreed and 32 patients strongly agreed that a right decision was made of their care. Of 15 patients who underwent emergency laparotomy, mean EQ-5D scores across all domains from improved from baseline (69 vs 78). Conclusions CNS led implementation of SDM is feasible, acceptable. Patients felt involved in their care and had lower levels of decisional regret. Encouraging and investing in an environment where health professionals take time to determine what is important to their patient can be associated with better outcomes.