Cardiac Surgery in The Frail and Elderly; Towards optimal decision making in a vulnerable population.

Before providing treatment for a disease doctors must obtain an 'informed consent'. It is important to provide patients with detailed information about the risks, benefits and alternatives to the proposed treatment. While this is a requirement that has been around for a long time, recent studies show that fewer than 30% of patients (30 in 100) understand the risks, benefits, and alternatives to any given treatment. This applies to surgical procedures, like cardiac (heart) surgery. It is even more important in groups where the risks are high. Over the last few years the patients facing potential cardiac surgery have become older, sicker, and are having more complex operations. Thus, their risks have increased. We propose to test an entirely new approach to 'informed consent' where we take patients through a formal teaching process where they learn about their disease, and its potential treatment options. Risks, benefits, and alternatives are emphasized, including not only risk of death, but issues of the likelihood of returning to the same or better quality of life as they currently have. This process will entail high quality educational materials and an informed consent form that details the particular patient's individual (patient specific) risks based on their risk factors. The entire process emphasizes patient choice, and demands that the patients take an active role in choosing the treatment that is best for them. This approach is called shared decision making, and recognizes the patients as the experts in their values and goals for their lives. To show if we are making a difference with this new approach we will assess: Patient Comprehension of the procedures and their disease; Patient Anxiety; Decisional Conflict (the degree to which patients feel confident and comfortable with their choice); and an exit interview where patients provide important information around the informed consent process that is not covered in the formal measures above.