E. M. Carlisle1,2, L. A. Shinkunas2, L. C. Kaldjian2 1University Of Iowa Hospitals And Clinics,Department Of Surgery, Division Of Pediatric Surgery,Iowa City, IA, USA 2University Of Iowa,Carver College Of Medicine, Program In Bioethics And Humanities,Iowa City, IA, USA
Introduction: Shared decision making (SDM) is frequently touted as the preferred approach to patient counseling. Some have even gone so far as to suggest that SDM improves quality of care and reduces healthcare costs. Despite such enthusiasm for SDM, little data exist regarding whether patients prefer SDM over a more physician-guided approach during complex surgical decision making. Even fewer data exist regarding surgeon attitudes toward SDM. Such issues may be especially pronounced in pediatric surgery given the complex decision-making triad that exists between patients, parents, and surgeons. In this systematic review we identified studies that address patient/parent and surgeon attitudes toward SDM in pediatric surgery.
Methods: We conducted a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) based systematic review of articles published in Medline, EMBASE, and Cochrane databases that evaluated surgeon and patient/parent preferences toward SDM in pediatric surgery. The search strategy was developed in conjunction with a medical librarian. Two investigators independently reviewed all identified articles to determine if they met inclusion criteria. Studies were included if they specifically investigated attitudes of surgeons or patients/parents toward SDM in pediatric surgery. Articles in the following categories were excluded: reviews, letters to the editor, editorials, suggested models of care, patient education handouts, decision making tools, devices, or articles without full text available.
Results: The search yielded 8368 articles. 784 duplicate articles were removed yielding 7584 articles for title/abstract review. If it was unclear whether an article should be included in the final analysis based upon review of title/abstract, the full text was reviewed. Our search strategy identified only 40 papers that specifically addressed SDM in pediatric surgery. Analysis of the articles is in progress and will include assessment of the following domains: surgeon sub-specialty, study location, clinical dilemma/decision needed, surgeon attitude toward SDM, patient/parent attitude toward SDM, and mention of decisional conflict or regret.
Conclusion: Despite recommendations that SDM is the best approach to clinical counseling in that it may improve quality of care and reduce healthcare costs, relatively few studies exist that address patient, parent, and surgeon satisfaction with SDM in pediatric surgery. Such research is imperative as it is quite possible that patients/parents may prefer a more physician-guided approach to complex surgical decision making. It is also reasonable to investigate whether surgeons believe SDM is an effective approach to discussions regarding surgery or whether they believe patient counseling would be more effective if more guidance was expected. Further research is required to gain a more complete understanding of how surgeons can best counsel patients/parents during decision making in pediatric surgery.