Mental health disorders are common in older people and are often unrecognised. Those living with mental health disorders who are being considered for vascular surgery have worse post operative outcomes, including longer length of hospital stay, higher readmission rates and emergency admissions to hospital. These patients also have more medical conditions contributing to their post surgery complications and poor health outcomes.
Surgery for vascular patients can include life changing operations, such as amputation, which impacts mental health and quality of life.
Shared decision making is the process whereby patients and clinicians work together to make evidence based decisions centred on patient values and preferences and is part of the Comprehensive Geriatric Assessment and optimisation (CGA) model of care. SDM has been shown to improve patient experience through provision of realistic choice, enhanced interaction with clinicians, greater empowerment and increased confidence and trust in healthcare provision. Implementing SDM in vascular patients can be particularly challenging. Evaluating and communicating benefits and risks of available treatments for CLTI in a complex older patient population requires additional consideration beyond the inherent surgical risks. To achieve truly informed SDM, the clinician requires knowledge of the impact of co-existing conditions on postoperative recovery, the natural history of the surgical pathology with and without surgery and an awareness of the benefits and risks of alternative treatments underpinned by skilful communication.
Inclusion Criteria
- Patients
- Aged ≥65 years old
- CLTI
- Active symptoms of anxiety or depression (clinician concern)
- Carers
o In a non-paid caring role for a patient aged ≥65 years with CLTI and active symptoms of anxiety or depression
- Staff o Healthcare professional (vascular surgeons, therapists, clinical nurse specialists, geriatricians, anaesthetists, pharmacists) providing care for people aged ≥65 years with CLTI
Exclusion Criteria
- Patients
- Palliative - death anticipated within one month
- Clinical and research team identify as lacking capacity to participate
- Carers
o Clinical and research team identify as lacking capacity to participate
- Staff o Not providing care for older people with CLTI