Systematic review of shared decision-making in surgery

Abstract

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.

The use of PROMs and shared decision‐making in medical encounters with patients: An opportunity to deliver value‐based health care to patients

“…This requires cooperation and activation of both clinicians and patients. Despite being so heavily embraced by scientific scholars and policymakers, formal implementation of SDM in practice has proven to be challenging . One key barrier seems to be the perceived time needed to practice SDM, addressing both risk communication and clarification of patients' values .…”

“…One key barrier seems to be the perceived time needed to practice SDM, addressing both risk communication and clarification of patients' values . Although clinicians generally support SDM, they are also often hesitant to practice it and often revert to a more authoritarian conversational model …”

“…Despite being so heavily embraced by scientific scholars and policymakers, formal implementation of SDM in practice has proven to be challenging. 3,[7][8][9][10] One key barrier seems to be the perceived time needed to practice SDM, [11][12][13] addressing both risk communication and clarification of patients' values. 12,14,15 Although clinicians generally support SDM, they are also often hesitant to practice it and often revert to a more authoritarian conversational model.…”

“…12,14,15 Although clinicians generally support SDM, they are also often hesitant to practice it and often revert to a more authoritarian conversational model. 10,[16][17][18] In the Netherlands, the recent emphasis on value-based health care (VBHC) in health policy is thought to provide new opportunities for SDM, especially by using information based on patient-reported outcome measures (PROMs) in routine medical encounters. VBHC is a health care delivery model organized around patients' needs, 19 aimed at improving outcomes that matter to patients/populations while optimizing resource utilization.…”

Trends in Shared Decision-Making Studies From 2009 to 2018: A Bibliometric Analysis

“…For example, a current project (26) is underway to develop a core outcome set to improve reporting of outcomes and consent processes. A systematic review to identify features of SDM in surgery conducted by de Mik et al (27) showed that surgeons and patients both recognized SDM, although SDM in surgery is in its infancy. Therefore, strategies to effectively practice and assess SDM in surgery are particularly important.…”