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Surgical Consultation as Social Process: Implications for Shared Decision Making.

Justin T Clapp1, Alexander F Arriaga1,2, Sushila Murthy1

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Surgical consultations often deviate from shared decision-making (SDM) ideals. Pre-existing factors and surgeon influence can overshadow patient preferences and risk discussions during surgical decision-making.

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Area of Science:

  • Medical Sociology
  • Health Services Research
  • Surgical Decision-Making

Background:

  • Shared decision-making (SDM) emphasizes patient preferences and risk/benefit discussions.
  • Empirical evidence shows a gap between SDM principles and actual surgical decision-making processes.
  • Qualitative research is crucial for understanding discrepancies in surgical decision-making.

Purpose of the Study:

  • To qualitatively examine surgical consultations as a social process.
  • To assess the alignment of surgical consultations with shared decision-making (SDM) model assumptions.
  • To identify factors influencing discrepancies in surgical decision-making.

Main Methods:

  • Observation of 45 consultations between 3 general surgeons and patients undergoing elective hernia repair or cholecystectomy.
  • Semi-structured interviews with patients and surgeons.
  • Qualitative analysis of the consultation process.

Main Results:

  • Decisions were often predisposed by events prior to the consultation.
  • Surgeons demonstrated authority in defining patient conditions and arbitrating interventions.
  • Upstream dynamics frequently diminished the focus on risk/benefit discussions central to SDM.

Conclusions:

  • Decision-making models should incorporate broader temporal and contextual factors.
  • SDM may overestimate patient influence due to surgeon's authority in defining conditions and controlling care.
  • Further research is needed on SDM-oriented decision aids in altering the social process of surgical decision-making.