Practice, Policy, and Research Recommendations to Improve Decision-Making about Surgery for People Living with Dementia

Objective: Identify consensus-based policy and practice recommendations and develop research priorities to enhance surgical decision-making in the context of dementia. Summary Background Data: People Living with Dementia (PLWD) and their families and healthcare providers face clinical, ethical, and psychosocial challenges when making surgical decisions. Methods: 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. Results: 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. Conclusions: This study provides direction to inform surgical practice, policy development, and future research to support surgical decision-making for PLWD, families, and clinicians.