Family Practice, Vol 14, 216-219, Copyright © 1997 by World Organization of Family Doctors
OP Ryynanen, M Myllykangas, J Kinnunen and J Takala
OBJECTIVES: We aimed to examine the relationship between doctors'
willingness to refer elderly patients for elective surgical operations and
patients' age, comorbidity, institutionalization, living habits and signs
of dementia. METHOD: A random selection of 837 medical doctors in Finland
(response rate 56%) received a postal questionnaire consisting of 18
vignettes, i.e. imaginary patient cases. Respondents were asked whether
they would refer the patient on the vignette for elective surgical
operation, treat the patient conservatively, or choose some other
alternative. In the vignettes, the age of patients was randomly varied
between 65 and 85, at 5-year intervals, to provide eight different
questionnaires, and each respondent obtained one of them. RESULTS: The
proportion of doctors willing to refer the patients for surgery was
inversely related to the patients' age: in all the vignettes, doctors said
they would refer fewer patients in the oldest age groups. Almost all the
doctors claimed they would refer healthy, home-dwelling persons aged 65-70
years for operations. In the oldest age groups of patients, the doctors'
willingness to refer was highest for cataract operations (69%) and hip
prosthesis operations (63%), but only 18% of doctors would refer such
patients for coronary by-pass operations. Comorbidity and
institutionalization were associated with fewer doctors referring the
patients: the proportion of doctors willing to refer these patients was
about half that of those willing to refer otherwise healthy and
home-dwelling patients. Smoking by patients also decreased the proportions
of doctors willing to refer, but moderate signs of dementia in an elderly
patient with cataract were associated with only a slight decrease in
referring. CONCLUSIONS: Doctors are less willing to refer old patients for
elective surgery, but comorbidity, patients' lifestyle and
institutionalization have a greater effect on referrals than age.
ORIGINAL CLINICAL RESEARCH
Doctors' willingness to refer elderly patients for elective surgery
Department of Community Health, University of Kuopio, Finland.
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