Redesigning Surgical Decision Making for High-Risk Patients

Published in: New England Journal of Medicine, Volume 370, pages 1379–1381 (April 2014). doi: 10.1056/NEJMp1315538

Posted on RAND.org on December 30, 2020

by Laurent G. Glance, Turner M. Osler, Mark D. Neuman

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One third of elderly Americans undergo surgery during the last 12 months of their lives, most of them within the last month. Yet three quarters of seriously ill patients say they would not choose life-sustaining treatment if they knew the outcome would be survival with severe cognitive or functional impairment. How many of these patients and their caregivers are offered less invasive options? How should such patients be counseled about the risks of complications and functional impairment after major surgery? And who should help them weigh the risks against the potential benefits of surgery?

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