Which factors influence the approach to shared decision-making among surgeons performing complex operations?

ABSTRACT

Background:

Shared decision-making (SDM) aims to create a context in which patients and surgeons work together to explore treatment options and goals of care. The objective of the current study was to characterize demographic factors, behaviors, and perceptions of patient involvement among surgeons relative to SDM.

Methods:

Using a cross-sectional survey methodology, surgeon demographics, behaviors, and perceptions of patient involvement were assessed. Surgeon approaches to SDM were measured using a 100-point scale ranging from ‘patient-led’ (0) to ‘surgeon-led’ (100).

Results:

Among 241 respondents, most were male (n = 123, 67.2%) and White (n = 124, 69.3%); roughly one-half of surgeons had been in practice ≥10 years (n = 120, 52.4%). Surgeon approaches to SDM ranged from 0 to 81.0, with a median rating of 50.0 (IQR: 35.5, 62.0). Reported approaches to SDM were associated with years in practice, sharing information, and perceptions of patient involvement. Surgeons in practice 10 + years most frequently utilized a ‘Shared, Patient-led’ approach to SDM (27.5%), while individuals with less experience more often employed a ‘Shared, Surgeon-led’ approach (33.3%, p = 0.031). Surgeons with a ‘Patient-led’ approach perceived patient involvement as most important (M = 3.82, SD = 0.16), while respondents who had a ‘Surgeon-led’ approach considered this less important (M = 3.57, SD = 0.38; p < 0.001).

Conclusion:

Surgeon factors including demographics, behaviors, and perceptions of patient involvement influenced SDM approaches. SDM between patients and surgeons should strive to be more dynamic and tailored to each specific patient’s needs to promote optimal patient-centered care.

KEYWORDS:

• surgery
• complex surgery
• shared decision-making
• clinical decision-making
• health communication
• physician-patient communication

Disclosure statement

No potential conflict of interest was reported by the author(s).

Authors contribution

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by EPK, LAR, and TMP. The first draft of the manuscript was written by EPK and TMP and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Data availability

Data will be shared upon reasonable request to the corresponding author.

Additional information

Notes on contributors

Elizabeth Palmer Kelly

Elizabeth Palmer Kelly, PhD – Research Scientist at The Ohio State University Comprehensive Cancer Center.

Laura J. Rush

Laura Rush, DVM, PhD, RN – Director of the Learning Health System Core in The Ohio State University Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research.

Halia L. Melnyk

Halia Melnyk, PhD, MPH, BSN – Post-doctoral researcher in The Ohio State University Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research.

Jennifer L. Eramo

Jennifer Eramo, MSN, RN, AHN-BC, CPHQ – Assistant Director of the Experience Core in The Ohio State University Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research.

Ann Scheck McAlearney

Ann Scheck McAlearney, ScD, MS – Executive Director of The Ohio State University Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research and Associate Dean for Health Services Research.

Timothy M. Pawlik

Tim Pawlik, MD, PhD, MPH, MBA – Surgical Oncologist with a focus on treating patients with liver, gallbladder, pancreatic, and neuroendocrine tumors. He is currently the chair of Surgery at The Ohio State University Wexner Medical Center.