Shared Decision-Making in General Surgery: Prospective Comparison of Telemedicine vs In-Person Visits.

Area of Science:

• Healthcare Delivery
• Surgical Care
• Telemedicine Research

Background:

• The COVID-19 pandemic accelerated the adoption of virtual telemedicine appointments in surgical care.
• The quality of shared decision-making during these virtual consultations remains understudied.
• Previous assumptions suggested telemedicine may negatively impact shared decision-making quality.

Purpose of the Study:

• To investigate the association between telemedicine visits and the quality of shared decision-making in general surgery.
• To compare patient and surgeon experiences in in-person versus virtual consultations.
• To identify factors influencing the quality of care in telemedicine surgical appointments.

Main Methods:

• A mixed-methods, prospective, observational cohort study was conducted.
• 387 patients attending first-time general surgery clinic visits were included (May 2021-June 2022).
• Shared decision-making was assessed using CollaboRATE and the 9-item Shared Decision-Making Questionnaire, alongside qualitative analysis.

Main Results:

• Telemedicine visits (22.2%) showed no statistically significant difference in shared decision-making quality compared to in-person visits (77.8%).
• Primary outcomes (CollaboRATE top box score) and secondary outcomes (9-item SDM Questionnaire) were comparable between visit types.
• Qualitative themes highlighted patient and surgeon perspectives on physical presence, time, appropriateness, technical issues, and communication.

Conclusions:

• This study indicates that telemedicine appointments do not negatively impact the quality of shared decision-making in general surgery.
• The findings suggest that virtual consultations can be as effective as in-person visits for shared decision-making.
• Further research may explore optimizing telemedicine for surgical consultations based on identified qualitative themes.