Shared Decision Making in Vascular Surgery: An Exploratory Study

Santema, T.B.; Stubenrouch, Fabiënne E.; Koelemay, M.J.W.; Vahl, A.C.; Vermeulen, Christine; Visser, M.J.T.; Ubbink, Dirk T.

doi:10.1016/j.ejvs.2015.12.010

Cited by 65 publications

(65 citation statements)

References 33 publications

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“…The low level of patient involvement in decision-making as found in this study is in agreement with earlier studies in various other clinical settings, [5, 13] so there is room for improvement. Clearly, the majority of anesthesiology clinicians were still insufficiently aware of what SDM entails.…”

Section: Discussionsupporting

confidence: 92%

“…assessing the level of patient involvement in SDM), it was not used for a sample size calculation. Moreover, in other similar studies using the OPTION scale, sample sizes the number of rated consultations per study ranged from 8 to 352, averaging 95 [5, 13, 14]. Despite this relatively small patient sample, it is not likely that a larger sample size would have resulted in a different conclusion.…”

Section: Discussionmentioning

confidence: 99%

“…For this descriptive part of the study, we planned to include an average of 5 patients per care professional to account for possible intra-clinician variation, as suggested in a previous study [5]. A sample size of 68 consultations would be sufficient to detect an intermediate effect size of 0.4 regarding the differences between the SDM-Q and Collaborate questionnaires, using a Mann-Whitney U-test with a 0.05 two-sided significance level and a 90% power.…”

Section: Methodsmentioning

confidence: 99%

“…To compare the results of individual clinicians, we only chose clinicians in whom at least five recordings were made to reliably detect any intra-clinician variation [5]. …”

Section: Methodsmentioning

confidence: 99%

“…However, many healthcare providers mainly focus on the finding and application of evidence, while the SDM-aspect tends to be neglected [3]. This became particularly clear from studies in surgical settings [4, 5]. …”

Section: Introductionmentioning

confidence: 99%

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The current level of shared decision-making in anesthesiology: an exploratory study

et al. 2017

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BackgroundShared decision-making (SDM) seeks to involve both patients and clinicians in decision-making about possible health management strategies, using patients’ preferences and best available evidence. SDM seems readily applicable in anesthesiology.We aimed to determine the current level of SDM among preoperative patients and anesthesiology clinicians.MethodsWe invited 115 consecutive preoperative patients, visiting the pre-assessment outpatient clinic of the department of Anesthesiology at the Academic Medical Center of Amsterdam. Inclusion criteria were patients who needed surgery in the arms, lower abdomen or legs, and in whom three anesthesia techniques were feasible. The SDM-level of the consultation was scored objectively by independent observers who judged audio-recordings of the consultation using the OPTION5-scale, ranging from 0% (no SDM) to 100% (optimum SDM), as well as subjectively by patients (using the SDM-Q-9 and CollaboRATE questionnaires) and clinicians (SDM-Q-Doc questionnaire). Objective and subjective SDM-levels were assessed on five-point and six-point Likert scales, respectively. Both scores were expressed as percentages.ResultsData of 80 patients could be analysed. Objective SDM-scores were low (30.5%). Subjective scores of the SDM-Q-9 and CollaboRATE were high among patients (91.7% and 96.3%, respectively) and among clinicians (SDM-Q-Doc; 84.3%). Apparently, they appreciated satisfaction rather than SDM, being poorly aware of what SDM entails.ConclusionThe level of SDM in an outpatient anesthesiology clinic where preoperative patients receive information about various possible anesthesia options, was found to be low. Thus, there is room for improving the level of SDM. Some suggestions are given how this can be achieved.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…To compare the results of individual clinicians, we only chose clinicians in whom at least five recordings were made to reliably detect any intra-clinician variation [5]. …”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The current level of shared decision-making in anesthesiology: an exploratory study

et al. 2017

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Systematic review of shared decision-making in surgery

Mik

Stubenrouch

Balm

et al. 2018

British Journal of Surgery

126

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BackgroundMultiple treatment options are generally available for most diseases. Shared decision‐making (SDM) helps patients and physicians choose the treatment option that best fits a patient's preferences. This review aimed to assess the extent to which SDM is applied during surgical consultations, and the metrics used to measure SDM and SDM‐related outcomes.MethodsThis was a systematic review of observational studies and clinical trials that measured SDM during consultations in which surgery was a treatment option. Embase, MEDLINE and CENTRAL were searched. Study selection, quality assessment and data extraction were conducted by two investigators independently.ResultsThirty‐two articles were included. SDM was measured using nine different metrics. Thirty‐six per cent of 13 176 patients and surgeons perceived their consultation as SDM, as opposed to patient‐ or surgeon‐driven. Surgeons more often perceived the decision‐making process as SDM than patients (43·6 versus 29·3 per cent respectively). SDM levels scored objectively using the OPTION and Decision Analysis System for Oncology instruments ranged from 7 to 39 per cent. Subjective SDM levels as perceived by surgeons and patients ranged from 54 to 93 per cent. Patients experienced a higher level of SDM during consultations than surgeons (93 versus 84 per cent). Twenty‐five different SDM‐related outcomes were reported.ConclusionAt present, SDM in surgery is still in its infancy, although surgeons and patients both think of it favourably. Future studies should evaluate the effect of new interventions to improve SDM during surgical consultations, and its assessment using available standardized and validated metrics.

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Decisional Conflict in Patients with Advanced Laryngeal Carcinoma: A Multicenter Study

Heirman,

de Kort,

Petersen

et al. 2024

The Laryngoscope

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ObjectivesDecision‐making for patients with a locally advanced laryngeal carcinoma (T3 and T4) is challenging due to the treatment choice between organ preservation and laryngectomy, both with different and high impact on function and quality of life (QoL). The complexity of these treatment decisions and their possible consequences might lead to decisional conflict (DC). This study aimed to explore the level of DC in locally advanced laryngeal carcinoma patients facing curative decision‐making, and to identify possible associated factors.MethodsIn this multicenter prospective cohort study, participants completed questionnaires on DC, level of shared decision‐making (SDM), and a knowledge test directly after counseling and 6 months after treatment. Descriptive statistics and Spearman correlation tests were used to analyze the data.ResultsDirectly after counseling, almost all participants (44/45; 98%) experienced Clinically Significant DC score (CSDC >25, scale 0–100). On average, patients scored 47% (SD 20%) correct on the knowledge test. Questions related to radiotherapy were answered best (69%, SD 29%), whilst only 35% (SD 29%) of the questions related to laryngectomy were answered correctly. Patients' perceived level of SDM (scale 0–100) was 70 (mean, SD 16.2), and for physicians this was 70 (SD 1.7).ConclusionMost patients with advanced larynx cancer experience high levels of DC. Low knowledge levels regarding treatment aspects indicate a need for better patient counseling.Level of EvidenceLevel IV Laryngoscope, 2024

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Shared Decision Making in Vascular Surgery: An Exploratory Study

Abstract: Currently, objective SDM behaviour among vascular surgeons is limited, even though the presented disorders allow for SDM. Hence, SDM in vascular surgical consultations could be improved by increasing the patients' and surgeons' awareness and knowledge about the concept of SDM.

Cited by 65 publications

References 33 publications

The current level of shared decision-making in anesthesiology: an exploratory study

The current level of shared decision-making in anesthesiology: an exploratory study

Systematic review of shared decision-making in surgery

Decisional Conflict in Patients with Advanced Laryngeal Carcinoma: A Multicenter Study

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