Shared decision-making for postoperative analgesia: A semistructured qualitative study

Area of Science:

• Medical decision-making
• Healthcare implementation science
• Patient engagement

Background:

• Shared decision-making (SDM) and decision-support tools are recognized for improving healthcare decisions.
• Implementation and impact on patient evaluation and decisional conflict are not well understood, especially in anesthesiology.
• Pre-operative SDM and decision-support tool use for postoperative analgesia remain under-explored.

Purpose of the Study:

• To understand pre-operative shared decision-making (SDM) in the context of major thoracic and abdominal surgery.
• To evaluate the utility of a decision-support tool for postoperative pain management.
• To explore patient and professional perspectives on information provision and decision-making processes.

Main Methods:

• A qualitative study design utilizing semistructured, in-depth interviews.
• Interviews were conducted with 10 individual patients and two focus groups comprising 8 professionals each.
• Participants were recruited from a university medical center and a nonacademic teaching hospital.

Main Results:

• Professionals often provided information focused on epidural analgesia benefits, neglecting risks, and not tailoring it to patient needs.
• Patients reported minimal involvement in decision-making but did not desire more; they viewed the decision-support tool positively but felt it wouldn't alter their choice.
• Professionals doubted patients' understanding and the tool's clinical usability due to potential misinterpretation.

Conclusions:

• Adherence to established shared decision-making (SDM) principles was lacking among both patients and professionals when discussing postoperative analgesia.
• The study highlights a gap between ideal SDM practices and real-world application in surgical contexts.
• Further research is needed to optimize SDM and decision-support tool implementation in anesthesiology.