Shared decision making’s adolescence and transition into adulthood

Clayman, Marla L.

doi:10.1016/j.pec.2018.08.010

Cited by 2 publications

(2 citation statements)

References 14 publications

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“…9,10 Recently, a push has begun to integrate patient decision aids-tools that inform patients about treatment options and their risks and benefits-into anesthesia consultations to increase patient participation in decision-making. [11][12][13] This effort occurs at a time of contradiction around shared decision-making: while many researchers and policymakers seek its routine measurement and implementation, 8,14,15 a growing chorus is skeptical of its feasibility and implications. [16][17][18] Given the ambiguous nature of the anesthesia consultation, associated uncertainty about how it should best be carried out, and the current energy behind launching decisionmaking interventions in this space, there is a need for better empirical understanding of conversations between anesthesiologists and surgical patients.…”

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confidence: 99%

“…9,10 Recently, a push has begun to integrate patient decision aids—tools that inform patients about treatment options and their risks and benefits—into anesthesia consultations to increase patient participation in decision-making. 11–13 This effort occurs at a time of contradiction around shared decision-making: while many researchers and policymakers seek its routine measurement and implementation, 8,14,15 a growing chorus is skeptical of its feasibility and implications. 16–18…”

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Patient Involvement in Anesthesia Decision-making: A Qualitative Study of Knee Arthroplasty

et al. 2021

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Background Calls to better involve patients in decisions about anesthesia—e.g., through shared decision-making—are intensifying. However, several features of anesthesia consultation make it unclear how patients should participate in decisions. Evaluating the feasibility and desirability of carrying out shared decision-making in anesthesia requires better understanding of preoperative conversations. The objective of this qualitative study was to characterize how preoperative consultations for primary knee arthroplasty arrived at decisions about primary anesthesia. Methods This focused ethnography was performed at a U.S. academic medical center. The authors audio-recorded consultations of 36 primary knee arthroplasty patients with eight anesthesiologists. Patients and anesthesiologists also participated in semi-structured interviews. Consultation and interview transcripts were coded in an iterative process to develop an explanation of how anesthesiologists and patients made decisions about primary anesthesia. Results The authors found variation across accounts of anesthesiologists and patients as to whether the consultation was a collaborative decision-making scenario or simply meant to inform patients. Consultations displayed a number of decision-making patterns, from the anesthesiologist not disclosing options to the anesthesiologist strictly adhering to a position of equipoise; however, most consultations fell between these poles, with the anesthesiologist presenting options, recommending one, and persuading hesitant patients to accept it. Anesthesiologists made patients feel more comfortable with their proposed approach through extensive comparisons to more familiar experiences. Conclusions Anesthesia consultations are multifaceted encounters that serve several functions. In some cases, the involvement of patients in determining the anesthetic approach might not be the most important of these functions. Broad consideration should be given to both the applicability and feasibility of shared decision-making in anesthesia consultation. The potential benefits of interventions designed to enhance patient involvement in decision-making should be weighed against their potential to pull anesthesiologists’ attention away from important humanistic aspects of communication such as decreasing patients’ anxiety. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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