Shared Decision-Making in Acute Surgical Illness: The Surgeon's Perspective. J Am Coll Surg 2018 May;226(5):784-795
Date
02/01/2018Pubmed ID
29382560DOI
10.1016/j.jamcollsurg.2018.01.008Scopus ID
2-s2.0-85042847957 (requires institutional sign-in at Scopus site) 28 CitationsAbstract
BACKGROUND: Surgical patients increasingly have more comorbidities and are of an older age, complicating surgical decision-making in emergent situations. Little is known about surgeons' perceptions of shared decision-making in these settings.
STUDY DESIGN: Twenty semi-structured interviews were conducted with practicing surgeons at 2 large academic medical centers. Thirteen questions and 2 case vignettes were used to assess perceptions of decision-making, considerations when deciding whether to offer to operate, and communication patterns with patients and families.
RESULTS: Thematic analysis revealed 6 major themes: responsibility for the decision to operate, perceived futility, surgeon judgment, surgeon introspection, pressure to operate, and costs of the operation. Perceived futility was universally considered a contraindication to surgical intervention. However, the challenge of defining futility led participants to emphasize the importance of patients' self-determined risk-to-benefit analysis when considering surgical intervention. More experienced surgeons reported greater comfort with communicating to patients that a condition was not amenable to an operation and reserved the right to refuse to operate.
CONCLUSIONS: Due to external pressures and uncertainty, some providers err on the side of operative intervention, despite suspected futility. Greater experience allows surgeons to withstand external pressures, be confident in their assessments of perceived futility, and guide patients and their families away from additional interventions.
Author List
Morris RS, Ruck JM, Conca-Cheng AM, Smith TJ, Carver TW, Johnston FMAuthors
Thomas W. Carver MD Associate Professor in the Surgery department at Medical College of WisconsinRachel S. Morris MD Assistant Professor in the Surgery department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
Academic Medical CentersAttitude of Health Personnel
Baltimore
Decision Making
Humans
Interviews as Topic
Medical Futility
Physician-Patient Relations
Professional-Family Relations
Surgeons
Surgical Procedures, Operative
Wisconsin
