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Qualitative Analysis03:46

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

Amalia M A van den Berg1, Peep F M Stalmeier, Gert Jan Scheffer

  • 1From the Department of Anaesthesiology, Pain and Palliative Medicine (AMAvdB, GJS, MJLB), Department for Health Evidence (PFMS) and Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands (RPH).

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Shared decision-making (SDM) principles were not followed for postoperative analgesia. Patients and professionals showed limited adherence to SDM, despite a decision-support tool

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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.