Shared Decision Making In Gynaecological Oncology; A Challenge In An Ageing Population

Key contentGynae-oncology patients are increasingly older and living with frailty and multimorbidity, resulting in higher rates of perioperative or treatment-associated adverse outcomes.Collaborative shared decision making (SDM), where healthcare professionals and patients work in partnership to reach a treatment decision, can be used to engage patients in treatment decisions.Comprehensive geriatric assessment (CGA), a multidimensional, interdisciplinary process assessing medical, psychological and functional capabilities, can inform individualised management and SDM in older gynae-oncology patients with complex conditions.Evidence is emerging for the use of CGA to inform individualised management and underpin integrated care pathways and SDM for older people. This methodology is advocated in NHS England's Cancer Strategy through integrated pathways for older cancer patients with geriatrician involvement.Using clinical case studies, this review contextualises the application of SDM through CGA in older patients with gynaecological malignancy.Learning objectivesKnow that SDM takes proposed risks and benefits into account, together with projected disease progression with and without treatment and patient preferences.Understand that limitations to SDM in older people include the effects of multimorbidity, cognitive impairment and frailty, limited data on long-term clinician and patient-reported outcomes and frequent exclusion of older people from research trials.