E. M. Carlisle1, L. A. Shinkunas2, C. J. Klipowicz3, L. C. Kaldjian2 1University Of Iowa,Division Of Pediatric Surgery/Department Of Surgery,Iowa City, IA, USA 2University Of Iowa,Program In Bioethics And Humanities,Iowa City, IA, USA 3University Of Iowa,Department Of Anthropology,Iowa City, IA, USA
Introduction: Shared decision making (SDM) is presumed to be the preferred approach to patient counseling. However, few data exist regarding whether patients prefer SDM over a surgeon-guided approach during complex surgical decision making. Even less data exist regarding surgeon preferences toward SDM. In this systematic review we identified studies that address patient and surgeon preferences toward SDM in 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/patient preferences toward SDM in adult surgery. Two investigators independently reviewed all identified articles. Articles were included if they specifically investigated preferences of surgeons/patients toward SDM in adult surgery.
Results:The search yielded 20359 articles. 4988 duplicate articles were removed yielding 15371 articles for title/abstract review. 86 articles addressed preferences toward SDM in surgery. Complete analysis of the articles is currently underway. Preliminary results from the first 35 articles demonstrate the following: 13 subspecialties were represented: Surgical Oncology (34%), General Surgery (20%), Cardiac Surgery (11%), Orthopedic Surgery (11%), Plastic Surgery (11%), Gynecology (9%), Urology (9%), Vascular Surgery (9%), Neurosurgery (6%), Thoracic Surgery (6%), Transplantation (6%), Colorectal (3%), and Otolaryngology (3%). 43% of articles discussed decision making for patients with cancer. Of those, 80% focused on breast cancer. 60% were from non-US institutions, and 71% focused on outpatient decision making. 83% concentrated on patient preferences, and 20% focused on surgeon preferences. 51% discussed decisions between operative or nonoperative management, 34% discussed decisions among different surgical procedures, and 11% discussed decisions regarding the timing of surgery. No articles addressed decision making for emergency surgery. In the 7 articles addressing surgeon preferences, most surgeons favored SDM. For patients, 46% favored SDM, 23% surgeon-guided decision making, and 14% independent decision making.
Conclusion:Despite recommendations that SDM is the best approach to clinical counseling, our systematic review identified very few articles that evaluate patient and surgeon preferences toward SDM in surgery. The majority of articles focused on non-emergent, outpatient decision making related to oncologic diagnoses. Additionally, most studies were preformed outside of the US where different health care systems or attitudes toward physicians may impact decision making preferences. Further research is needed to understand whether patients and surgeons may prefer a more surgeon-guided approach to decision making in emergent, inpatient decision making. Additionally, more work is needed to assess decision making preferences for patients and surgeons focused on non-oncologic diagnoses.