Related Experiment Videos
Shared Decision-Making in Acute Surgical Illness: The Surgeon's Perspective
Rachel S Morris1, Jessica M Ruck2, Alison M Conca-Cheng2
1Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
Journal of the American College of Surgeons
|February 1, 2018
Summary
Surgeons grapple with decision-making for older patients with comorbidities. Experienced surgeons better navigate perceived futility and external pressures, guiding patients toward appropriate surgical interventions.
Area of Science:
- Medical Ethics
- Surgical Decision-Making
- Patient Care
Background:
- Aging populations and increasing comorbidities complicate emergent surgical decisions.
- Surgeons' perspectives on shared decision-making in these complex scenarios remain underexplored.
Purpose of the Study:
- To investigate surgeons' perceptions of decision-making processes for high-risk surgical patients.
- To understand factors influencing surgical offers and communication with patients and families.
Main Methods:
- Conducted 20 semi-structured interviews with surgeons at two academic medical centers.
- Utilized 13 questions and 2 case vignettes to explore decision-making, futility, and communication.
Main Results:
- Identified six key themes: responsibility, perceived futility, surgeon judgment, introspection, pressure to operate, and costs.
- Perceived futility emerged as a key contraindication, highlighting the importance of patient risk-benefit analysis.
- Experienced surgeons demonstrated greater confidence in refusing non-beneficial operations.
Conclusions:
- External pressures can lead to unnecessary surgeries, even with suspected futility.
- Surgeon experience enhances the ability to assess futility and guide patients away from interventions.
- Shared decision-making in complex surgical cases requires nuanced communication and experienced judgment.