Mechanisms of decision-making in preoperative assessment for older adult prostate cancer patients-A qualitative study

Patrick Kierkegaard 1, Mira D Vale 2, Spencer Garrison 2, Brent K Hollenbeck 3, John M Hollingsworth 3, Jason Owen-Smith 1

Affiliations

PMID: 31872469
PMCID: PMC7032018 (available on 2021-03-01)
DOI: 10.1002/jso.25819

Abstract

Background and objective: Little research exists which investigates the contextual factors and hidden influences that inform surgeons and surgical teams decision-making in preoperative assessment when deciding whether to or not to operate on older adult prostate cancer patients living with aging-associated functional declines and illnesses. The aim of this study is to identify and examine the underlying mechanisms that uniquely shape preoperative surgical decision-making strategies concerning older adult prostate cancer patients.

Methods: Qualitative methodologies were used that paired ethnographic field observations with semistructured interviews for data collection. An inductive thematic analysis approach was used to identify, analyze, and describe patterns in the data.

Results: Factors underlining surgical decision-making originated from the context of two categories: (1) clinical and surgery-specific factors; and (2) non-patient factors. Thematic subcategories included personal experiences, methods of assessment during medical encounters, anticipation of outcomes, perceptions of preoperative assessment instruments for frailty and multimorbidity, routines and workflow patterns, microcultures, and indirect observation and second-hand knowledge.

Conclusion: Surgeon's personal experiences has a significant impact on the decision-making processes during preoperative assessments. However, non-patient factors such as institutional microcultures passively and actively influence decision-making process during preoperative assessment.

Keywords: frailty; medical decision-making; multimorbidity; older adults; preoperative assessment; prostate cancer; surgical assessment.