eP695 - COAST: A Novel Shared Decision Making Tool for Older Adults

Purpose/Background: Purpose: Identify valid and feasible standards to guide the development of a surgeon-facing shared decision-making (SDM) tool for use with older adults in elective and emergent settingsBackground: Patient and clinician collaboration in a process of SDM is a key element of goal-concordant care. Older adults face increased risk of complications after surgery, including unique risks such as cognitive and functional decline. Additionally, their goals of treatment are often different from the general population, focusing on preserving quality of life and minimizing disability rather than prolonging life. Existing provider-facing SDM tools rarely incorporate the specific needs of older adults and often focused on patient risk assessment. This study consults patients, caregivers, and national clinical experts to define and refine valid and feasible standards of surgical SDM with older adults.Methods/Interventions:

Methods: A literature review and preliminary focus groups with patients and content experts were used to develop 19 standards with 31 substandards of SDM with older adults. A modified Delphi panel was then completed with 12 content experts from surgery, palliative care, geriatrics, social work, ethics as well as patient participants using the RAND/UCLA Appropriateness Methodology. Each standard was rated as valid and feasible on a scale of 1 to 9 on a first round of ratings via a REDCap survey. We then discussed these standards at a second virtual meeting and after the meeting a final rating was completed by 12 panel members. Standards were considered valid or feasible if they received a median validity or feasibility score ≥7 in the second round of ratings and there was statistical agreement (interpercentile range (IPR) adjusted for symmetry-IPR>0).Results/Outcomes:

Results: All 19 standards with 31 substandards of SDM were considered valid while one standard and 5 substandards were identified as having perceived barriers to feasibility. Barriers to implementation included time, knowledge/skills, cultural, and financial (Table 1).Conclusion/

Discussion:

Conclusion: The results of this Delphi study identified all 19 standards with 31 substandards to be valid with the vast majority also being feasible. These standards will be utilized to create a communication tool for surgical SDM for older adults.Perceived Barriers to Feasibility of Standards Developed for Surgical Decision Making with Older AdultsPerceived barriers included time, knowledge/skills, cultural, and financial