Ana C De Roo1, Crystal Ann Vitous2, Samantha J Rivard3, Michaela C Bamdad4, Sara M Jafri5, Mary E Byrnes6, Pasithorn A Suwanabol7. 1. Center for Healthcare Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor, MI. Electronic address: aderoo@med.umich.edu. 2. Center for Healthcare Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor, MI. 3. Center for Healthcare Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor, MI. Electronic address: https://twitter.com/rivardsj. 4. Center for Healthcare Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor, MI. Electronic address: https://twitter.com/michaelabamdad. 5. Center for Healthcare Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor, MI. Electronic address: https://twitter.com/sara_jafri1. 6. Center for Healthcare Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor, MI. Electronic address: https://twitter.com/sociologymary. 7. Center for Healthcare Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor, MI. Electronic address: https://twitter.com/amysuwanabol.
Abstract
BACKGROUND: Shared decision-making is critical to optimal patient-centered care. For elective operations, when there is sufficient time for deliberate discussion, little is known about how surgeons navigate decision-making and how surgeons align care with patient preferences. In this context, we sought to explore surgeons' approaches to decision-making for adults ≥65 years at high-risk of postoperative complications or death. METHODS: We conducted semistructured in-depth interviews with 46 practicing surgeons across Michigan. Transcripts were iteratively analyzed through steps informed by inductive thematic analysis. RESULTS: Four major themes emerged characterizing how surgeons approach high-risk surgical decision-making for older adults: (1) risk assessment was defined as the process used by surgeons to identify and analyze factors that may negatively impact outcome; (2) expectations and goals described the process of surgeons engaging with patients and families to discuss potential outcomes and desired objectives; (3) external and internal motivating factors outlined extrinsic dynamics (eg, quality metrics, referrals) and intrinsic drivers (eg, surgeons' personal experiences) that influenced high-risk decision-making; and (4) decision-making approaches and challenges encompassed the roles of patients and surgeons and obstacles to engaging in a true shared decision-making process. CONCLUSION: Although shared decision-making is strongly recommended, we found that surgeons who perform high-risk operations among older adults predominantly focused on assessing risk and setting expectations with patients and families rather than inviting them to actively participate in the decision-making process. Surgeons also reported influences on decision-making from quality metrics, referrals, and personal experiences. Patient involvement, however, was seldom discussed suggesting that surgeons may not be engaging in true shared decision-making when benefits should be weighed against a high likelihood of harm.
BACKGROUND: Shared decision-making is critical to optimal patient-centered care. For elective operations, when there is sufficient time for deliberate discussion, little is known about how surgeons navigate decision-making and how surgeons align care with patient preferences. In this context, we sought to explore surgeons' approaches to decision-making for adults ≥65 years at high-risk of postoperative complications or death. METHODS: We conducted semistructured in-depth interviews with 46 practicing surgeons across Michigan. Transcripts were iteratively analyzed through steps informed by inductive thematic analysis. RESULTS: Four major themes emerged characterizing how surgeons approach high-risk surgical decision-making for older adults: (1) risk assessment was defined as the process used by surgeons to identify and analyze factors that may negatively impact outcome; (2) expectations and goals described the process of surgeons engaging with patients and families to discuss potential outcomes and desired objectives; (3) external and internal motivating factors outlined extrinsic dynamics (eg, quality metrics, referrals) and intrinsic drivers (eg, surgeons' personal experiences) that influenced high-risk decision-making; and (4) decision-making approaches and challenges encompassed the roles of patients and surgeons and obstacles to engaging in a true shared decision-making process. CONCLUSION: Although shared decision-making is strongly recommended, we found that surgeons who perform high-risk operations among older adults predominantly focused on assessing risk and setting expectations with patients and families rather than inviting them to actively participate in the decision-making process. Surgeons also reported influences on decision-making from quality metrics, referrals, and personal experiences. Patient involvement, however, was seldom discussed suggesting that surgeons may not be engaging in true shared decision-making when benefits should be weighed against a high likelihood of harm.
Authors: Mirjam M Garvelink; Laura Boland; Krystal Klein; Don Vu Nguyen; Matthew Menear; Hilary L Bekker; Karen B Eden; Annie LeBlanc; Annette M O'Connor; Dawn Stacey; France Légaré Journal: Med Decis Making Date: 2019-05-29 Impact factor: 2.583
Authors: Margaret L Schwarze; Amber E Barnato; Paul J Rathouz; Qianqian Zhao; Heather B Neuman; Emily R Winslow; Gregory D Kennedy; Yue-Yung Hu; Christopher M Dodgion; Alvin C Kwok; Caprice C Greenberg Journal: JAMA Surg Date: 2015-04 Impact factor: 14.766
Authors: Glyn Elwyn; Marie Anne Durand; Julia Song; Johanna Aarts; Paul J Barr; Zackary Berger; Nan Cochran; Dominick Frosch; Dariusz Galasiński; Pål Gulbrandsen; Paul K J Han; Martin Härter; Paul Kinnersley; Amy Lloyd; Manish Mishra; Lilisbeth Perestelo-Perez; Isabelle Scholl; Kounosuke Tomori; Lyndal Trevena; Holly O Witteman; Trudy Van der Weijden Journal: BMJ Date: 2017-11-06
Authors: Alexander T Hawkins; Russell Rothman; Timothy M Geiger; Kemberlee R Bonnet; Matthew G Mutch; Scott E Regenbogen; David G Schlundt; David F Penson Journal: Ann Surg Open Date: 2022-05-04