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. 2020 Oct;23(5):1241-1249.
doi: 10.1111/hex.13105. Epub 2020 Jul 22.

Shared decision making in surgery: A scoping review of the literature

Kacper Niburski  1 , Elena Guadagno  2 , Sadaf Mohtashami  2 , Dan Poenaru  2
Affiliations

Shared decision making in surgery: A scoping review of the literature

Kacper Niburski et al. Health Expect. 2020 Oct.

Abstract

Background: Shared decision making (SDM) has been increasingly implemented to improve health-care outcomes. Despite the mixed efficacy of SDM to provide better patient-guided care, its use in surgery has not been studied. The aim of this study was to systematically review SDM application in surgery.

Design: The search strategy, developed with a medical librarian, included nine databases from inception until June 2019. After a 2-person title and abstract screen, full-text publications were analysed. Data collected included author, year, surgical discipline, location, study duration, type of decision aid, survey methodology and variable outcomes. Quantitative and qualitative cross-sectional studies, as well as RCTs, were included.

Results: A total of 6060 studies were retrieved. A total of 148 were included in the final review. The majority of the studies were in plastic surgery, followed by general surgery and orthopaedics. The use of SDM decreased surgical intervention rate (12 of 22), decisional conflict (25 of 29), and decisional regret (5 of 5), and increased decisional satisfaction (17 of 21), knowledge (33 of 35), SDM preference (13 of 16), and physician trust (4 of 6). Time increase per patient encounter was inconclusive. Cross-sectional studies showed that patients prefer shared treatment and surgical treatment varied less. The results of SDM per type of decision aid vary in terms of their outcome.

Conclusion: SDM in surgery decreases decisional conflict, anxiety and surgical intervention rates, while increasing knowledge retained decisional satisfaction, quality and physician trust. Surgical patients also appear to prefer SDM paradigms. SDM appears beneficial in surgery and therefore worth promoting and expanding in use.

Keywords: patient-centred care; shared decision making; surgery.

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Figures

FIGURE 1
FIGURE 1
Identification of eligible studies in scoping review
FIGURE 2
FIGURE 2
The seven types of decisional aids used to apply shared decision making
FIGURE 3
FIGURE 3
Trends of DA‐specific measures. Blue marks increase, red decrease, and yellow no change
FIGURE 4
FIGURE 4
DA type with associated primary outcomes: surgery increased (blue), decisional conflict decreased (red), and time spent increased (yellow) using SDM
See this image and copyright information in PMC

References

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