Shared Decision Making and Choice for Elective Surgical Care

Boss, Emily F.; Mehta, Nishchay; Nagarajan, Neeraja; Links, Anne R.; Benke, James R.; Berger, Zackary; Espinel, Alexandra G.; Meier, Jeremy D.; Lipstein, Ellen A.

doi:10.1177/0194599815620558

Cited by 168 publications

(165 citation statements)

References 59 publications

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“…When presenting for surgical evaluation, patients engage in a shared-decision making process with the surgical team gauging the risks and benefits of each management strategy. 9 …”

Section: Introductionmentioning

confidence: 99%

Multifactor Influences of Shared Decision-Making in Acoustic Neuroma Treatment

Nellis

Sharon

Pross

et al. 2017

Otology &Amp; Neurotology

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Objective To identify factors associated with treatment modality selection in acoustic neuromas. Study Design Prospective observational study Setting Tertiary care neurotology clinic Patients Data was prospectively collected from patients initially presenting to a tertiary care neurotology clinic between 2013 and 2016. Patients who did not have MRI, demographic, psychometric, or audiometric data were excluded from analysis. Intervention Demographic information, clinical symptoms, tumor characteristics, and psychometric data were collected to determine factors associated with undergoing acoustic neuroma surgical resection using univariate and multiple logistic regression analysis. Main Outcome Measure The decision to pursue acoustic neuroma surgical resection versus active surveillance. Results A total of 216 patients with acoustic neuroma (mean age 55 years, 58% female) were included. 98 patients (45.4%) pursued surgical resection, 118 patients (54.6%) pursued active surveillance. Surgical treatment was significantly associated with patient age < 65, higher grade tumors, growing tumors, larger volume tumors, lower word discrimination scores, Class D hearing, headache and vertigo as presenting symptoms, higher number of total symptoms, and higher headache severity scores (p<0.05). There was no significant association between surgical intervention and preoperative quality of life, depression, and self-esteem scores. On multiple logistic regression analysis, the likelihood of undergoing surgical resection significantly decreased for patients older than age 65 (OR 0.19; 0.05-0.69) and increased in patients with medium (OR 4.34; 1.36-13.81), moderately large (OR 33.47; 5.72-195.83), large grade tumors (OR 56.63; 4.02-518.93), tumor growth present (OR 4.51; 1.66-12.28), Class D hearing (OR 3.96; 1.29-12.16), and higher headache severity scores (OR 1.03;95% CI 1.01-1.05). The likelihood of undergoing surgical resection was completely predictive for giant grade tumors and not significant for small grade tumors and Class B or C hearing. Conclusions Non-elderly acoustic neuroma patients with larger tumors, growing tumors, significant hearing loss, and worse headaches are more likely to pursue surgical resection rather than active surveillance. Psychological factors such as quality of life, depression, and self-esteem do not seem to influence decision-making in this patient population.

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“…When presenting for surgical evaluation, patients engage in a shared-decision making process with the surgical team gauging the risks and benefits of each management strategy. 9 …”

Section: Introductionmentioning

confidence: 99%

Multifactor Influences of Shared Decision-Making in Acoustic Neuroma Treatment

Nellis

Sharon

Pross

et al. 2017

Otology &Amp; Neurotology

View full text Add to dashboard Cite

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“…Respect for autonomy also provides the theoretical and psychological foundation for shared decision-making and many forms of behavior change counseling, such as motivational interviewing. In the ambulatory setting, patient understanding and involvement in treatment plans (shared decision making) is seen as essential because these plans tend to be carried out by the patient, whereas in the inpatient setting, they tend to be carried out on the patient [2,3].…”

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confidence: 99%

Communication behaviors and patient autonomy in hospital care: A qualitative study

Berger

Boss

Beach

2017

Patient Education and Counseling

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A B S T R A C TBackground: Little is known about how hospitalized patients share decisions with physicians. Methods: We conducted an observational study of patient-doctor communication on an inpatient medicine service among 18 hospitalized patients and 9 physicians. A research assistant (RA) approached newly hospitalized patients and their physicians before morning rounds and obtained consent. The RA audio recorded morning rounds, and then separately interviewed both patient and physician. Coding was done using integrated analysis. Results: Most patients were white (61%) and half were female. Most physicians were male (66%) and of Southeast Asian descent (66%). All physicians explained the plan of care to the patients; most believed that their patient understood. However, many patients did not. Physicians rarely asked the patient for their opinion. In all those cases, the decision had been made previously by the doctors. No decisions were made with the patient. Patients sometimes disagreed. Conclusions: Shared decision-making may not be the norm in hospital care. Although physicians do explain treatment plans, many hospitalized patients do not understand enough to share in decisions. When patients do assert their opinion, it can result in conflict. Practice implications: Some hospitalized patients are interested in discussing treatment. Improving hospital communication can foster patient autonomy.

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“…The degree to which patients with tetraplegia prefer non-invasive treatments overall is not completely understood, but warrants further investigation as several subjects expressed a generalized fear of surgery, and patients’ preference for non-operative treatment is becoming increasingly recognized. 58–60 …”

Section: Discussionmentioning

confidence: 99%

Checkpoints to Progression: Qualitative Analysis of the Personal and Contextual Factors That Influence Selection of Upper Extremity Reconstruction Among Patients With Tetraplegia

Harris

Muller

Shauver

et al. 2017

The Journal of Hand Surgery

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Purpose Patients with tetraplegia consistently rank better use of the upper extremity as their top functional priority. Multiple case series have demonstrated that Upper Extremity Reconstruction (UER) is well-tolerated and can produce substantial functional improvements for appropriate candidates; however, UER remains critically underutilized. The mechanisms that drive differences in provider practice and referral patterns have been studied, but comprehensive examination of the patient factors that influence UER decisions has not been performed for American patients. Methods Nineteen patients with C4-C8 cervical spinal injuries were selected using purposive sampling: 9 patients had undergone UER, 10 had not undergone UER. Semi-structured interviews were conducted and transcripts evaluated using grounded theory methodology. Results Our study yielded a conceptual model that describes the characteristics common to all patients who undergo UER. Patients who selected reconstruction proceeded stepwise through a shared sequence of steps: 1) functional dissatisfaction 2) awareness of UER and 3) acceptance of surgery. Patients’ ability to meet these criteria was determined by three checkpoints: how well they coped, their access to information, and the acceptability of surgery. Extremely positive or negative coping prevented patients from moving from the Coping to the Information Checkpoint; thus, they remained unaware of UER and did not undergo surgery. A lack of knowledge regarding reconstruction was the strongest barrier to surgery among our participants. Conclusions We built a conceptual model that outlines how patients’ personal and contextual factors drive their progression to UER. Moving from functional dissatisfaction to understanding that they were candidates for UER was a substantial barrier for participants, particularly those with very high and very low coping skills. Clinical Relevance To improve utilization for all patients, interventions are needed to increase UER awareness. Standardizing introduction to UER during the rehabilitation process or improving e-content may represent key awareness access points.

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Shared Decision Making and Choice for Elective Surgical Care

Cited by 168 publications

References 59 publications

Multifactor Influences of Shared Decision-Making in Acoustic Neuroma Treatment

Multifactor Influences of Shared Decision-Making in Acoustic Neuroma Treatment

Communication behaviors and patient autonomy in hospital care: A qualitative study

Checkpoints to Progression: Qualitative Analysis of the Personal and Contextual Factors That Influence Selection of Upper Extremity Reconstruction Among Patients With Tetraplegia

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