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Multicenter Study
. 2025 Sep 1;282(3):449-459.
doi: 10.1097/SLA.0000000000006796. Epub 2025 Jun 18.

Over One-Third of Surgical Patients Report Inadequate Shared Decision-Making: Opportunities for Improvement From the ACS NSQIP PROMs Project

Jason B Liu  1   2   3 , Anoosha Moturu  4 , Larissa K F Temple  5   6 , Zara R Cooper  2   3   7 , Bruce L Hall  4   8 , Clifford Y Ko  4   9 , Andrea L Pusic  1   2   3
Affiliations
Multicenter Study

Over One-Third of Surgical Patients Report Inadequate Shared Decision-Making: Opportunities for Improvement From the ACS NSQIP PROMs Project

Jason B Liu et al. Ann Surg. .

Abstract

Objective: This study aimed to identify patient, surgeon, and hospital characteristics associated with inadequate shared decision-making (SDM) after surgery.

Background: SDM that incorporates patients' preferences, values, and goals is integral to setting expectations and delivering high-quality patient-centered surgical care.

Methods: This retrospective cohort study of 65 US hospitals analyzed data from the American College of Surgeons National Surgical Quality Improvement Program Patient-Reported Outcomes Measures Project. Multilevel logistic regression incorporating available patient, surgeon, and hospital characteristics modeled inadequate SDM as measured by 2 validated patient-reported SDM measures: CollaboRATE and the SDM-Q-9.

Results: Across 30,957 patients and 2921 surgeons, 36.5% (CollaboRATE: 11226/30957) to 57.7% (SDM-Q-9: 16358/28363) of patients reported inadequate SDM. Upon multivariable analysis, inadequate SDM was significantly associated with postoperative complications, Medicaid or Medicare coverage relative to commercial insurance, and having nonambulatory procedures. Further, patients were more likely to report inadequate SDM if their surgeons were male and in either Orthopedic Surgery, Urology, or Vascular Surgery, relative to General Surgery. Patients cared for at Rural Referral Centers were also more likely to report inadequate SDM.

Conclusions: SDM is an essential component of high-quality, patient-centered care, yet this study identified that over a third of surgical patients reported inadequate SDM. Attention paid to improving SDM is critical, as SDM is not only a priority for patients and families but also may soon become a national quality performance standard.

Keywords: patient experience; patient-reported outcomes; quality improvement; shared decision-making.

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Conflict of interest statement

A.L.P. is the co-developer of the Q portfolio of measures and receives royalties when they are used for commercial purposes. The remaining authors report no conflicts of interest.

References

    1. Angelos P, Taylor LJ, Roggin K, et al. Decision-making in surgery. Ann Thorac Surg. 2024;117:1087–1094.
    1. Hughes TM, Merath K, Chen Q, et al. Association of shared decision-making on patient-reported health outcomes and healthcare utilization. Am J Surg. 2018;216:7–12.
    1. Brown TT, Hurley VB, Rodriguez HP, et al. Shared decision-making lowers medical expenditures and the effect is amplified in racially-ethnically concordant relationships. Med Care. 2023;61:528–535.
    1. Liu JB, Pusic AL, Gibbons CJ, et al. Association of patient-reported experiences and surgical outcomes among group practices: retrospective cohort study. Ann Surg. 2020;271:475–483.
    1. Schwarze ML, Arnold RM, Clapp JT, et al. Better conversations for better informed consent: talking with surgical patients. Hastings Cent Rep. 2024;54:11–14.

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