Shared Decision Making and Choice for Elective Surgical Care: A Systematic Review

Area of Science:

• Health Services Research
• Patient-Provider Communication
• Surgical Outcomes

Background:

• Shared decision making (SDM) integrates patient values with evidence to enhance care quality and evidence-based practice.
• The role of SDM in elective surgical settings remains underexplored, particularly concerning its impact on treatment choices and utilization.

Purpose of the Study:

• To systematically review and synthesize existing research on the use and outcomes of SDM in elective surgical care.
• To evaluate how SDM influences patient preferences and decision-making processes in surgical contexts.

Main Methods:

• A comprehensive systematic review of studies published from January 1, 1990, to August 9, 2015.
• Searches were conducted across major databases including PubMed, Cochrane CENTRAL, EMBASE, CINAHL, and SCOPUS.
• Data extraction focused on study design, population, clinical dilemma, SDM implementation, outcomes, and bias.

Main Results:

• Twenty-four studies met inclusion criteria, with spine, joint, and gynecologic surgeries being the most common areas examined.
• Decision aids, including multimedia and personal coaching, were utilized in 20 studies.
• SDM demonstrated a mixed effect on surgical preference, improved decision quality and patient knowledge, and reduced decision conflict.

Conclusions:

• Shared decision making is effective in reducing decision conflict and enhancing decision quality for patients considering elective surgery.
• While SDM may lead to a decrease in surgical uptake, its definitive impact on overall surgical utilization remains unclear.