The current level of shared decision-making in anesthesiology: an exploratory study

Abstract

Background: Shared decision-making (SDM) seeks to involve both patients and clinicians in decision-making about possible health management strategies, using patients' preferences and best available evidence. SDM seems readily applicable in anesthesiology. We aimed to determine the current level of SDM among preoperative patients and anesthesiology clinicians.

Methods: We invited 115 consecutive preoperative patients, visiting the pre-assessment outpatient clinic of the department of Anesthesiology at the Academic Medical Center of Amsterdam. Inclusion criteria were patients who needed surgery in the arms, lower abdomen or legs, and in whom three anesthesia techniques were feasible. The SDM-level of the consultation was scored objectively by independent observers who judged audio-recordings of the consultation using the OPTION⁵-scale, ranging from 0% (no SDM) to 100% (optimum SDM), as well as subjectively by patients (using the SDM-Q-9 and CollaboRATE questionnaires) and clinicians (SDM-Q-Doc questionnaire). Objective and subjective SDM-levels were assessed on five-point and six-point Likert scales, respectively. Both scores were expressed as percentages.

Results: Data of 80 patients could be analysed. Objective SDM-scores were low (30.5%). Subjective scores of the SDM-Q-9 and CollaboRATE were high among patients (91.7% and 96.3%, respectively) and among clinicians (SDM-Q-Doc; 84.3%). Apparently, they appreciated satisfaction rather than SDM, being poorly aware of what SDM entails.

Conclusion: The level of SDM in an outpatient anesthesiology clinic where preoperative patients receive information about various possible anesthesia options, was found to be low. Thus, there is room for improving the level of SDM. Some suggestions are given how this can be achieved.

Keywords: Patient education; Preoperative period; Shared decision-making; Surgical procedures, operative.

Fig. 1

Flowchart of patient inclusion

Fig. 2

OPTION scores per item. OPTION items: 1 = Identifying a problem(s) needing a decision making process; 2 = the provider will support/explain the need to deliberate about the options; 3 = the provider list the options and explains the pros/cons; 4 = the provider explores the personal preference of the patient; 5 = the provider makes an effort to integrate the patient’s preferences as decisions are either made by the patient or arrives at by a process of collaboration and discussion. OPTION scores: 0 = not observed; 1 = there is a perfunctory or unclear attempt to perform the behavior; 2 = the behavior is performed at baseline skill level; 3 = the behavior is performed to a good standard; 4 = the behavior is performed to a high standard. Boxes represent values between 25th and 75th percentiles, whiskers the upper and lower adjacent values and the horizontal lines represent the median values. Outliers are displayed as asterisks

Fig. 3

OPTION scores per clinician. ‘A’ stands for anesthetists, ‘AT’ stands for anesthetists in training and ‘AA’ stands for anesthesiology assistant

Fig. 4

Bland-Altman plot of the differences between SDM-Q-9 and SDM-Q-Doc scores. The middle horizontal line indicates the mean difference between SDM-Q-9 and SDM-Q-Doc, while the upper and lower horizontal lines show the 95% limits of agreement

Fig. 5

SDM-Q-Doc scores of each of the clinicians. ‘A’ stands for anesthetists, ‘AT’ stands for anesthetists in training and ‘AA’ stands for anesthesiology assistant