Surgeons’ Views on Shared Decision-Making

Authors

Suraj Kannan, Johns Hopkins UniversityFollow
Jayhyun Seo, Johns Hopkins UniversityFollow
Kevin R. Riggs, University of Alabama at Birmingham; Birmingham VA Medical CenterFollow
Gail Geller, Division of Pediatrics, Johns Hopkins University School of MedicineFollow
Emily F. Boss, Pediatric Otolaryngology, Johns Hopkins University School of MedicineFollow
Zackary D. Berger, Division of General Internal Medicine, Johns Hopkins University School of MedicineFollow

Publication Date

1-27-2020

Keywords

shared decision-making, surgical decision-making, patient-centered care, surgery, perception

Abstract

Purpose: Shared decision-making (SDM) has a significant role in surgical encounters, where decisions are influenced by both clinician and patient preferences. Herein, we sought to explore surgeons’ practices and beliefs about SDM.

Methods: We performed a qualitative study consisting of semi-structured individual interviews with 18 surgeons from private practice and academic surgery practices in Baltimore, Maryland. We purposively sampled participants to maximize diversity of practice type (academic vs private), surgical specialty, gender, and experience level. Interview topics included benefits and challenges to patient involvement in decision-making, communicating uncertainty to patients, and use of decision aids. Interviews were audio-recorded and transcribed. Transcripts were analyzed using content analysis to identify themes.

Results: Surgeons were supportive of patients being involved in decision-making, particularly in cases with uncertainty about treatment options. However, surgeons identified SDM as being more appropriate for patients whom surgeons perceived as interested in decision-making involvement and for decisions in which surgeons did not have strong preferences. Additionally, surgeons reported typically presenting only a subset of available options, remaining confident in their ability to filter less suitable options based on intuitive risk assessments. Surgeons differed in their approach to making recommendations, with some guiding patients towards what they saw as the correct or optimal decision while others sought to maintain neutrality and support of the patients’ chosen decision.

Conclusions: Many surgeons do not believe SDM is universally optimal for every surgical decision. They instead use assessments of patient disposition or potential clinical uncertainty to guide their perceived appropriateness of using SDM.

Recommended Citation

Kannan S, Seo J, Riggs KR, Geller G, Boss EF, Berger ZD. Surgeons’ views on shared decision-making. J Patient Cent Res Rev. 2020;7:8-18. doi: 10.17294/2330-0698.1718