Shared decision making in surgery: a scoping review of patient and surgeon preferences

Abstract

Background Many suggest that shared decision-making (SDM) is the most effective approach to clinical counseling. It is unclear if this applies to surgical decision-making-especially regarding urgent, highly-morbid operations. In this scoping review, we identify articles that address patient and surgeon preferences toward SDM in surgery. Methods We used the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR) to develop our protocol. Medline, EMBASE, and Cochrane databases were searched from inception through 11.2017. Title/abstract review identified peer-reviewed, empirical articles that addressed patient/surgeon preferences toward SDM in surgery. Identified articles underwent full review by two independent investigators. We addressed the following questions: (1) What is known from existing empirical evidence about patients’ and/or surgeons’ surgical decision-making preferences? (2) Why might patients and/or surgeons prefer SDM? (3) Does acuity of intervention impact surgical decision-making preferences? Outcome measures included study methods, surgical specialty, diagnosis, study location/setting, type/number of subjects, acuity of intervention, surgeon/patient decision-making preferences, and factors associated with favoring SDM. Data was analyzed in Microsoft Excel. Results 20,359 articles were identified with 4988 duplicates, yielding 15,371 articles for title/abstract review. 74 articles were included in final analysis. 68% of articles discussed oncologic decision-making. 46% of these focused on breast cancer. 92% of articles included patients, 22% included surgeons. 75% of articles found surgeons favored SDM, 25% demonstrated surgeons favored surgeon guidance. 54% of articles demonstrated patients favored SDM, 35% showed patients favored surgeon guidance, 11% showed patients preferred independent decision-making. The most common factors for patients favoring SDM included female gender, higher education, and younger age. For surgeons, the most common factors for favoring SDM included limited evidence for a given treatment plan, multiple treatment options, and impact on patient lifestyle. No articles evaluated decision-making preferences in an emergent setting. Conclusions There has been limited evaluation of patient and surgeon preferences toward SDM in surgical decision-making. Generally, patients and surgeons expressed preference toward SDM. None of the articles evaluated decision-making preferences in an emergent setting, so assessment of the impact of acuity on decision-making preferences is limited. Extension of research to complex, emergent clinical settings is needed.

Discrepancies in decision making preferences between parents and surgeons in pediatric surgery

“…It is possible that patient and surgeon preferences toward the degree of surgeon guidance vary depending on the perceived urgency or complexity of a given setting. In our review of the literature, we did not find any studies that assessed this possibility [16,17]. Most studies assume that patients and surgeons interpret the urgency and complexity of clinical situations similarly, however this has never been shown empirically.…”

“…Consideration of such operations for pediatric patients may further heighten concern. Our recent work demonstrates that relatively little has been published on patient or surgeon preferences toward SDM in surgery [16,17]. Those studies that do exist overwhelmingly focus upon elective, non-urgent decisionmaking [16,17].…”

“…Our recent work demonstrates that relatively little has been published on patient or surgeon preferences toward SDM in surgery [16,17]. Those studies that do exist overwhelmingly focus upon elective, non-urgent decisionmaking [16,17]. It is possible that patient and surgeon preferences toward the degree of surgeon guidance vary depending on the perceived urgency or complexity of a given setting.…”

Association of shared decision making with inpatient satisfaction: a cross-sectional study

“…Moreover, informed consent before surgery is required not only as a legal doctrine but also as patient-centered care [ 39 ]. SDM in inpatients undergoing surgery helps physicians understand patients’ values, preferences, and needs and helps patients understand the benefits and risks of surgical alternatives to reduce physician–patient conflict and protect patient interests [ 40 , 41 ]. These factors may explain the better SDM in the inpatients who underwent any surgery.…”

Association of shared decision making with inpatient satisfaction: A cross-sectional study

“…Moreover, informed consent before surgery is required not only as a legal doctrine but also as patient-centered care [39]. SDM in inpatients undergoing surgery helps physicians understand patients' values, preferences, and needs and helps patients understand the bene ts and risks of surgical alternatives to reduce physician-patient con ict and protect patient interests [40,41]. These factors may explain the better SDM in the inpatients who underwent any surgery.…”