Practice, Policy, and Research Recommendations to Improve Decision-Making about Surgery for People Living with Dementia: A Delphi Panel Consensus.

Abstract

Identify consensus-based policy and practice recommendations and develop research priorities to enhance surgical decision-making in the context of dementia. People Living with Dementia (PLWD) and their families and healthcare providers face clinical, ethical, and psychosocial challenges when making surgical decisions. We conducted a modified Delphi panel August-December 2024, consisting of interviews, surveys, and virtual discussions. Panel members rated potential recommendations on importance and feasibility for practice and policy recommendations, and priority for research recommendations. 23 stakeholders, including surgeons, other clinicians, researchers, policy experts, PLWD and care partners participated on the panel. Policy and practice recommendations (n=28) and research recommendations (n=21) covered the following domains: 1) Obtaining information about cognitive impairment, physical function, capacity to consent, and general goals of care for patients with surgical conditions; 2) Advancing resources to support surgical decision-making in the context of dementia; 3) Enhancing care collaboration and team-based care for patients with surgical conditions in the context of dementia; 4) Using policy to enhance surgical decision-making for patients living with dementia; 5) Increasing surgical clinician knowledge and understanding of the dementia context. Of 28 policy and practice recommendations rated by the panel, 25 achieved consensus for high importance but uncertain feasibility, 2 reached consensus for both high importance and feasibility, and 1 remained uncertain on both importance and feasibility. All 21 research recommendations reached consensus for high priority. This study provides direction to inform surgical practice, policy development, and future research to support surgical decision-making for PLWD, families, and clinicians.