{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T22:53:39Z","timestamp":1785884019514,"version":"3.56.0"},"reference-count":62,"publisher":"Georg Thieme Verlag KG","issue":"05","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clin Colon Rectal Surg"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Older adults require disproportionately more operations and suffer more complications than their younger counterparts, making a thoughtful approach to shared decision-making imperative. This article reviews key considerations in the decision to pursue operative intervention for older adults. First, we explore the \u201cFix It\u201d model and the importance of acknowledging trade-offs, with a specific focus on quality of life. This is followed by a discussion of how surgical recovery affects physical function, bowel function, and cognition. We describe strategies for shared decision-making in the older population, specifically eliciting patient preferences for overall health goals, establishing the goals of surgery, discussing advanced directives, and engaging caregivers. We anticipate these key content areas will provide surgeons with important insights with which to approach surgical decision-making for this vulnerable patient group.<\/jats:p>","DOI":"10.1055\/a-2760-7343","type":"journal-article","created":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T00:04:56Z","timestamp":1766534696000},"page":"357-363","source":"Crossref","is-referenced-by-count":0,"title":["Unique Challenges of Shared Decision-Making in Colorectal Surgery for the Elderly Patient"],"prefix":"10.1055","volume":"39","author":[{"given":"Madhuri V.","family":"Nishtala","sequence":"additional","affiliation":[{"name":"Department of Surgery, School of Medicine and Public Health, University of Wisconsin\u2013Madison, Madison, Wisconsin, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia R.","family":"Berian","sequence":"additional","affiliation":[{"name":"Department of Surgery, School of Medicine and Public Health, University of Wisconsin\u2013Madison, Madison, Wisconsin, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,12,23]]},"reference":[{"issue":"03","key":"ref1","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1056\/NEJM198007173030304","article-title":"Aging, natural death, and the compression of morbidity","volume":"303","author":"J F Fries","year":"1980","journal-title":"N Engl J Med"},{"issue":"11","key":"ref2","doi-asserted-by":"crossref","first-page":"1250","DOI":"10.1001\/archsurg.1976.01360290084012","article-title":"Is 80 years too old for aneurysmectomy?","volume":"111","author":"T F O'Donnell","year":"1976","journal-title":"Arch Surg"},{"issue":"04","key":"ref3","first-page":"139","article-title":"Surgical mortality among the elderly. An analysis of 4,050 operations (1970-1974)","volume":"8","author":"A D Turnbull","year":"1978","journal-title":"Clin Bull"},{"issue":"6620","key":"ref4","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1136\/bmj.296.6620.459","article-title":"Resection for colorectal cancer in the very old: are the risks too high?","volume":"296","author":"A AM Lewis","year":"1988","journal-title":"Br Med J (Clin Res Ed)"},{"issue":"03","key":"ref5","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1097\/SLA.0b013e3181b45598","article-title":"Redefining geriatric preoperative assessment using frailty, disability and co-morbidity","volume":"250","author":"T N Robinson","year":"2009","journal-title":"Ann Surg"},{"issue":"03","key":"ref6","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1097\/CCM.0b013e3181cc466b","article-title":"Surgical \u201cbuy-in\u201d: the contractual relationship between surgeons and patients that influences decisions regarding life-supporting therapy","volume":"38","author":"M L Schwarze","year":"2010","journal-title":"Crit Care Med"},{"issue":"04","key":"ref7","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1097\/SLA.0000000000000714","article-title":"\u201cAnd I think that we can fix it\u201d: mental models used in high-risk surgical decision making","volume":"261","author":"J M Kruser","year":"2015","journal-title":"Ann Surg"},{"issue":"14","key":"ref8","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1056\/NEJMsa012528","article-title":"Understanding the treatment preferences of seriously ill patients","volume":"346","author":"T R Fried","year":"2002","journal-title":"N Engl J Med"},{"issue":"10","key":"ref9","doi-asserted-by":"crossref","first-page":"1557","DOI":"10.1001\/jamainternmed.2016.4362","article-title":"States worse than death among hospitalized patients with serious illnesses","volume":"176","author":"E B Rubin","year":"2016","journal-title":"JAMA Intern Med"},{"issue":"03","key":"ref10","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1055\/s-0038-1677027","article-title":"Overlooked long-term complications of colorectal surgery","volume":"32","author":"M D Giglia","year":"2019","journal-title":"Clin Colon Rectal Surg"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"832377","DOI":"10.3389\/fonc.2022.832377","article-title":"Functional bowel complaints and the impact on quality of life after colorectal cancer surgery in the elderly","volume":"12","author":"S HJ Ketelaers","year":"2022","journal-title":"Front Oncol"},{"issue":"12","key":"ref12","doi-asserted-by":"crossref","first-page":"1878","DOI":"10.1007\/s10350-006-0725-9","article-title":"The impact of surgery for colorectal cancer on quality of life and functional status in the elderly","volume":"49","author":"T M Mastracci","year":"2006","journal-title":"Dis Colon Rectum"},{"issue":"09","key":"ref13","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1007\/s11912-019-0830-2","article-title":"Health-related quality of life in older adults with colorectal cancer","volume":"21","author":"E Lapinsky","year":"2019","journal-title":"Curr Oncol Rep"},{"issue":"02","key":"ref14","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.jgo.2017.09.005","article-title":"The impact of postoperative complications on health-related quality of life in older patients with rectal cancer; a prospective cohort study","volume":"9","author":"A M Couwenberg","year":"2018","journal-title":"J Geriatr Oncol"},{"issue":"10","key":"ref15","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1001\/jamasurg.2023.3650","article-title":"Innovations in surgical communication 4-present the downsides of surgery, not just risks","volume":"158","author":"S I Zaza","year":"2023","journal-title":"JAMA Surg"},{"issue":"02","key":"ref16","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1016\/j.surg.2013.10.002","article-title":"What does it really mean to \u201crecover\u201d from an operation?","volume":"155","author":"L Lee","year":"2014","journal-title":"Surgery"},{"key":"ref17","volume-title":"Provide Your Opinion, Don't Hide It","author":"K L Haug","year":"2023"},{"issue":"05","key":"ref18","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1016\/j.jamcollsurg.2004.05.280","article-title":"Functional independence after major abdominal surgery in the elderly","volume":"199","author":"V A Lawrence","year":"2004","journal-title":"J Am Coll Surg"},{"issue":"10","key":"ref19","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1001\/jamasurg.2020.2853","article-title":"Evaluation of postoperative functional health status decline among older adults","volume":"155","author":"L M Zhang","year":"2020","journal-title":"JAMA Surg"},{"issue":"09","key":"ref20","doi-asserted-by":"crossref","first-page":"e161689","DOI":"10.1001\/jamasurg.2016.1689","article-title":"Association of loss of independence with readmission and death after discharge in older patients after surgical procedures","volume":"151","author":"J R Berian","year":"2016","journal-title":"JAMA Surg"},{"issue":"05","key":"ref21","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1001\/jamasurg.2014.3176","article-title":"Risk of discharge to postacute care: a patient-centered outcome for the American College of Surgeons national surgical quality improvement program surgical risk calculator","volume":"150","author":"S Mohanty","year":"2015","journal-title":"JAMA Surg"},{"issue":"01","key":"ref22","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1097\/DCR.0000000000001541","article-title":"Long-term functional decline after high-risk elective colorectal surgery in older adults","volume":"63","author":"A C De Roo","year":"2020","journal-title":"Dis Colon Rectum"},{"issue":"01","key":"ref23","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1097\/ALN.0000000000005172","article-title":"2025 American Society of Anesthesiologists practice advisory for perioperative care of older adults scheduled for inpatient surgery","volume":"142","author":"F Sieber","year":"2025","journal-title":"Anesthesiology"},{"issue":"04","key":"ref24","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1097\/DCR.0000000000002410","article-title":"The American Society of Colon and Rectal Surgeons clinical practice guidelines for the perioperative evaluation and management of frailty among older adults undergoing colorectal surgery","volume":"65","author":"N M Saur","year":"2022","journal-title":"Dis Colon Rectum"},{"issue":"03","key":"ref25","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1097\/DCR.0000000000001583","article-title":"International consensus definition of low anterior resection syndrome","volume":"63","author":"C Keane","year":"2020","journal-title":"Dis Colon Rectum"},{"issue":"05","key":"ref26","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1097\/SLA.0b013e31824f1c21","article-title":"Low anterior resection syndrome score: development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer","volume":"255","author":"K J Emmertsen","year":"2012","journal-title":"Ann Surg"},{"key":"ref27","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1016\/j.ijsu.2018.06.031","article-title":"A meta-analysis of the prevalence of low anterior resection syndrome and systematic review of risk factors","volume":"56","author":"A D Croese","year":"2018","journal-title":"Int J Surg"},{"issue":"03","key":"ref28","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1007\/s10151-021-02561-1","article-title":"Trajectory of change of low anterior resection syndrome over time after restorative proctectomy for rectal adenocarcinoma","volume":"26","author":"F Al-Rashid","year":"2022","journal-title":"Tech Coloproctol"},{"issue":"02","key":"ref29","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1080\/08941939.2020.1864684","article-title":"Temporal changes of low anterior resection syndrome score after sphincter preservation: a prospective cohort study on repetitive assessment of rectal cancer patients","volume":"35","author":"G E Theodoropoulos","year":"2022","journal-title":"J Invest Surg"},{"issue":"01","key":"ref30","doi-asserted-by":"crossref","first-page":"5","DOI":"10.3393\/ac.2016.32.1.5","article-title":"Quality of life after a low anterior resection in elderly patients","volume":"32","author":"B C Kim","year":"2016","journal-title":"Ann Coloproctol"},{"issue":"05","key":"ref31","first-page":"993","article-title":"Quality of life in patients living with stoma","volume":"31","author":"W C Zewude","year":"2021","journal-title":"Ethiop J Health Sci"},{"issue":"12","key":"ref32","doi-asserted-by":"crossref","first-page":"1966","DOI":"10.1002\/alz.12362","article-title":"Population estimate of people with clinical Alzheimer's disease and mild cognitive impairment in the United States (2020-2060)","volume":"17","author":"K B Rajan","year":"2021","journal-title":"Alzheimers Dement"},{"issue":"20","key":"ref33","doi-asserted-by":"crossref","first-page":"2110","DOI":"10.1001\/jama.2014.4573","article-title":"Preoperative assessment of the older patient: a narrative review","volume":"311","author":"L B Oresanya","year":"2014","journal-title":"JAMA"},{"issue":"12","key":"ref34","doi-asserted-by":"crossref","first-page":"1134","DOI":"10.1001\/jamasurg.2015.2606","article-title":"Effect of delirium and other major complications on outcomes after elective surgery in older adults","volume":"150","author":"L J Gleason","year":"2015","journal-title":"JAMA Surg"},{"issue":"05","key":"ref35","first-page":"430","article-title":"One-year Medicare costs associated with delirium in older patients undergoing major elective surgery","volume":"156","author":"R Y Gou","year":"2021","journal-title":"JAMA Surg"},{"key":"ref36","doi-asserted-by":"crossref","first-page":"111221","DOI":"10.1016\/j.jclinane.2023.111221","article-title":"Association between postoperative delirium and adverse outcomes in older surgical patients: a systematic review and meta-analysis","volume":"90","author":"E Yan","year":"2023","journal-title":"J Clin Anesth"},{"issue":"02","key":"ref37","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1002\/gps.5241","article-title":"A qualitative exploration of the views of patients and their relatives regarding interventions to minimize the distress related to postoperative delirium","volume":"35","author":"C Meilak","year":"2020","journal-title":"Int J Geriatr Psychiatry"},{"issue":"02","key":"ref38","doi-asserted-by":"crossref","first-page":"e13297","DOI":"10.1111\/nicc.13297","article-title":"Patients' and family members' dyadic experience of post-operative delirium in the intensive care unit: a qualitative study","volume":"30","author":"J Dong","year":"2025","journal-title":"Nurs Crit Care"},{"key":"ref39","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1056\/NEJMoa1112923","article-title":"Cognitive trajectories after postoperative delirium","volume":"367","author":"J S Saczynski","year":"2012","journal-title":"N Engl J Med"},{"issue":"01","key":"ref40","doi-asserted-by":"crossref","first-page":"347","DOI":"10.3233\/JAD-170288","article-title":"Delirium severity post-surgery and its relationship with long-term cognitive decline in a cohort of patients without dementia","volume":"61","author":"S M Vasunilashorn","year":"2018","journal-title":"J Alzheimers Dis"},{"issue":"11","key":"ref41","doi-asserted-by":"crossref","first-page":"1373","DOI":"10.1001\/jamaneurol.2020.2273","article-title":"Association of delirium with long-term cognitive decline: a meta-analysis","volume":"77","author":"T E Goldberg","year":"2020","journal-title":"JAMA Neurol"},{"issue":"01","key":"ref42","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1097\/SLA.0000000000002436","article-title":"Postoperative delirium as a target for surgical quality improvement","volume":"268","author":"J R Berian","year":"2018","journal-title":"Ann Surg"},{"issue":"01","key":"ref43","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1111\/jgs.13866","article-title":"Person-centered care: a definition and essential elements","volume":"64","author":"American Geriatrics Society Expert Panel on Person-Centered Care","year":"2016","journal-title":"J Am Geriatr Soc"},{"issue":"02","key":"ref44","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/j.cger.2016.01.012","article-title":"Patient priority-directed decision making and care for older adults with multiple chronic conditions","volume":"32","author":"M E Tinetti","year":"2016","journal-title":"Clin Geriatr Med"},{"issue":"10","key":"ref45","doi-asserted-by":"crossref","first-page":"1872","DOI":"10.1111\/jgs.15437","article-title":"Development of a clinically feasible process for identifying individual health priorities","volume":"66","author":"A D Naik","year":"2018","journal-title":"J Am Geriatr Soc"},{"issue":"04","key":"ref46","doi-asserted-by":"crossref","first-page":"e224","DOI":"10.1093\/geront\/gnab071","article-title":"Assessing what matters most in older adults with multicomplexity","volume":"62","author":"J Moye","year":"2022","journal-title":"Gerontologist"},{"issue":"01","key":"ref50","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/SLA.0000000000001491","article-title":"Recommendations for best communication practices to facilitate goal-concordant care for seriously ill older patients with emergency surgical conditions","volume":"263","author":"Z Cooper","year":"2016","journal-title":"Ann Surg"},{"issue":"03","key":"ref51","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1177\/0272989X20911870","article-title":"20th Anniversary Ottawa Decision Support Framework: part 3 overview of systematic reviews and updated framework","volume":"40","author":"D Stacey","year":"2020","journal-title":"Med Decis Making"},{"issue":"03","key":"ref52","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/S0738-3991(98)00026-3","article-title":"A decision aid for women considering hormone therapy after menopause: decision support framework and evaluation","volume":"33","author":"A M O'Connor","year":"1998","journal-title":"Patient Educ Couns"},{"issue":"10","key":"ref53","doi-asserted-by":"crossref","first-page":"e0240516","DOI":"10.1371\/journal.pone.0240516","article-title":"Planning and optimising CHAT&PLAN: a conversation-based intervention to promote person-centred care for older people living with multimorbidity","volume":"15","author":"T K Corbett","year":"2020","journal-title":"PLoS One"},{"issue":"10","key":"ref54","doi-asserted-by":"crossref","first-page":"994","DOI":"10.1001\/jamasurg.2023.3340","article-title":"Innovations in surgical communication 2-focus on the goals of surgery","volume":"158","author":"M L Schwarze","year":"2023","journal-title":"JAMA Surg"},{"issue":"03","key":"ref55","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1002\/hast.1587","article-title":"Better conversations for better informed consent: talking with surgical patients","volume":"54","author":"M L Schwarze","year":"2024","journal-title":"Hastings Cent Rep"},{"issue":"02","key":"ref56","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1177\/0272989X0102100207","article-title":"The role of risk and benefit perception in informed consent for surgery","volume":"21","author":"A Lloyd","year":"2001","journal-title":"Med Decis Making"},{"issue":"11","key":"ref57","doi-asserted-by":"crossref","first-page":"1685","DOI":"10.1016\/j.ejso.2018.08.003","article-title":"Personalized management of elderly patients with rectal cancer: Expert recommendations of the European Society of Surgical Oncology, European Society of Coloproctology, International Society of Geriatric Oncology, and American College of Surgeons Commission on Cancer","volume":"44","author":"I Montroni","year":"2018","journal-title":"Eur J Surg Oncol"},{"issue":"04","key":"ref58","doi-asserted-by":"crossref","first-page":"256","DOI":"10.7326\/0003-4819-153-4-201008170-00008","article-title":"Redefining the \u201cplanning\u201d in advance care planning: preparing for end-of-life decision making","volume":"153","author":"R L Sudore","year":"2010","journal-title":"Ann Intern Med"},{"issue":"03","key":"ref64","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1038\/s41591-024-03340-9","article-title":"Lifetime risk and projected burden of dementia","volume":"31","author":"M Fang","year":"2025","journal-title":"Nat Med"},{"issue":"08","key":"ref65","doi-asserted-by":"crossref","first-page":"1748","DOI":"10.1111\/jgs.14873","article-title":"Caregiver integration during discharge planning for older adults to reduce resource use: a metaanalysis","volume":"65","author":"J Rodakowski","year":"2017","journal-title":"J Am Geriatr Soc"},{"issue":"09","key":"ref66","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1001\/jamasurg.2023.2500","article-title":"Postdischarge caregiver burden among family caregivers of older trauma patients","volume":"158","author":"M Tabata-Kelly","year":"2023","journal-title":"JAMA Surg"},{"issue":"01","key":"ref67","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1186\/s12877-020-01579-8","article-title":"Caregiver strain on informal caregivers when providing care for older patients undergoing major abdominal surgery: a longitudinal prospective cohort study","volume":"20","author":"T L Janssen","year":"2020","journal-title":"BMC Geriatr"},{"issue":"10","key":"ref68","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1001\/jamasurg.2023.3476","article-title":"Innovations in surgical communication 3-promote deliberation, not technical education","volume":"158","author":"M L Schwarze","year":"2023","journal-title":"JAMA Surg"},{"issue":"07","key":"ref69","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1001\/jamasurg.2025.1061","article-title":"Innovations in surgical communication 5-when surgery is a bad idea, focus on the goals","volume":"160","author":"M L Schwarze","year":"2025","journal-title":"JAMA Surg"},{"issue":"09","key":"ref70","doi-asserted-by":"crossref","first-page":"1805","DOI":"10.1111\/jgs.13615","article-title":"\u201cBest case\/worst case\u201d: qualitative evaluation of a novel communication tool for difficult in-the-moment surgical decisions","volume":"63","author":"J M Kruser","year":"2015","journal-title":"J Am Geriatr Soc"}],"container-title":["Clinics in Colon and Rectal Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2760-7343.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T22:35:19Z","timestamp":1785882919000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2760-7343"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,23]]},"references-count":62,"journal-issue":{"issue":"05","published-online":{"date-parts":[[2026,8,4]]},"published-print":{"date-parts":[[2026,9]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2760-7343","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1531-0043","1530-9681"],"issn-type":[{"value":"1531-0043","type":"print"},{"value":"1530-9681","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,23]]}}}