EP866 - Piloting a Tool for Shared decision-making in frail older adults undergoing Colorectal Surgery

Monday, May 11, 2026

1:58 PM - 2:03 PM ET

ePoster Presenter(s)

Ashley Ferguson, MD

Postdoctoral Research Fellow
University of Rochester Medical Center
University of Rochester Medical Center
Rochester, NY, United States

Disclosure information not submitted.

Senior Author(s)

Gabriela Poles, MD, MPH (she/her/hers)

Associate Professor of Surgery
University of Rochester
University of Rochester Medical Center
Rochester, NY, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

JT

Janet N. Tran, BA

Medical Student
University of Rochester School of Medicine and Dentistry
Rochester, New York, United States

Disclosure information not submitted.
KH

Kathi L. Heffner, PhD

Professor
University of Rochester Medical Center
Rochester, New York, United States

Disclosure information not submitted.
Marcia Russell, MD (she/her/hers)

Professor of Surgery
David Geffen School of Medicine at UCLA; VA Greater Los Angeles Healthcare System
David Geffen School of Medicine at UCLA, VA Greater Los Angeles Healthcare System
Palos Verdes Estates, California, United States

Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.

Gabriela Poles, MD, MPH: This individual has no financial relationships with ineligible companies.

Purpose/Background: As the US population ages, older adults (age ≥ 65 yo) represent an increasing proportion of surgical patients. Frail older adults are particularly vulnerable to post-operative complications and functional decline that can impact their quality of life. Shared decision-making (SDM) is critical for aligning surgical decisions with the values and preferences of older adults, yet inconsistently implemented in surgical practice. To address this need, our group developed the Consent Older Adults for Surgery Tool (COAST), a structured communication tool designed to prompt discussion of patient goals, baseline health, treatment options, and decision preferences. In this pilot we explore implementation outcomes using COAST with surgeons and older adults, to further refine COAST, as well as identify barriers and facilitators to its integration into surgical practice.

Methods/Interventions: This qualitative implementation study was conducted at a single academic medical center from 7- 10/2024. Four surgeons representing general surgery/critical care, urology, and colorectal surgery piloted a novel SDM tool during conversations with 17 English-speaking patients aged ≥65 years undergoing inpatient or outpatient surgical evaluation. Semi-structured interviews were then conducted with surgeons to assess implementation outcomes (e.g. feasibility, usability, and barriers). Interviews were transcribed and thematically analyzed by the study team using the Consolidated Framework for Implementation Research (CFIR).

Results/Outcomes: Surgeons reported that COAST provided useful prompts and structure for eliciting patient goals and values, with relative advantages over usual practice. Interview transcripts were analyzed using a thematic approach guided by CFIR, which identifies five key domains influencing implementation, as shown in Figure 1. Key themes included (1) innovation-related factors such as design, adaptability, and relative advantage; (2) implementation processes including training needs, workflow integration, and strategies to engage providers and patients; (3) individual surgeon and patient characteristics, including communication patterns, openness, frailty, and values; and (4) organizational and systemic context, with time constraints and electronic health record integration identified as major barriers.

Conclusion/Discussion: A pilot SDM tool for older adults was feasible to implement in surgical practice and was valued for enhancing patient-centered conversations. Broader adoption will require workflow adaptation, training, and institutional support.

Figure 1: Proportion of Codes Across CFIR Domains

The distribution of codes across 5 Consolidated Framework for Implementation Research (CFIR) domains: intervention, outer settings, inner setting, individuals, and process.