Geriatric oncologist calls for shared decision-making after patient cancels surgery to preserve daily routine

Geriatric oncologist Ranjana Srivastava has published an opinion piece in The Guardian, arguing that the medical establishment must move beyond generic risk assessments to embrace shared decision-making. The article centres on a clinical case involving an elderly male patient diagnosed with early-stage cancer who initially cancelled his surgery appointment.

The patient, who is in his mid-80s, had been advised that surgery was the only cure for his condition. However, a subsequent conversation revealed that his primary priority was maintaining his independence. He described a daily routine that included tending his garden and buying fresh salad leaves for his daughter-in-law, activities that kept him functional and connected to his family.

After discussing the potential complications of the procedure, including delirium and infection, the patient realised that the risks to his quality of life outweighed the benefits. He ultimately declined the surgery, a decision Srivastava notes was only possible after the patient voiced what mattered to him most, rather than relying on a rushed consent process.

Srivastava identifies several barriers to effective shared decision-making, including subjective language such as "rare" or "likely," time pressures that lead to rushed consent, and knowledge gaps in medical training. She argues that doctors often fail to explain that patients have a real choice, including the option to say no, which can lead to decisional regret.

To address these challenges, the article recommends the use of plain-language tools to help patients advocate for themselves. Srivastava specifically highlights a guide developed by a geriatrician in Australia and resources from the UK’s National Health Service (NHS), which provide structured questions to facilitate better communication between doctors and patients.