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Measuring critical deficits in shared decision making before elective surgery.

Claire K Ankuda¹, Susan D Block², Zara Cooper³

¹Department of Family Medicine, University of Washington, Seattle, USA.

Patient Education and Counseling

|January 3, 2014

Summary

Over a third of patients have deficits in preoperative decision-making. Non-English speakers and those with lower education are at higher risk for incomplete informed consent and shared decision-making.

Keywords:

Health care disparities Shared surgical decision making

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Area of Science:

Medical Ethics
Surgical Patient Care
Health Disparities

Background:

Informed consent and shared decision-making are crucial for ethical surgical practice.
Identifying patient-specific needs in preoperative decision-making is clinically important.
Deficits in these processes can lead to suboptimal patient outcomes.

Purpose of the Study:

To examine patterns and predictors of deficiencies in informed surgical consent and shared decision-making.
To identify patient factors correlated with specific needs in preoperative decision-making.

Main Methods:

Surveyed 1034 preoperative patients using validated measures.
Employed principal component analysis to define correlated factor groupings.
Utilized multivariable analysis to assess patient factors associated with these groupings.

Main Results:

13% of patients had informed consent deficits; 33% had other deficits.
Deficits included lack of knowledge on procedures, risks, benefits, and unaddressed patient values.
Non-English language and lower educational level were correlated with higher risk for deficits.

Conclusions:

Over a third of patients experience deficits in preoperative decision-making.
Sociodemographic factors like language and education identify vulnerable groups.
Targeted interventions are needed to improve decision-making and reduce disparities.