Patient Reported Shared Decision Making in Urology from the Surgical Consumer Assessment of Healthcare Providers and...

Shared decision making balances the best available evidence with patients' preferences and values in order to make a medical decision. The use of shared decision making and its link to clinically meaningful outcomes are not well described in urology. We report the rates of shared decision making among patients undergoing urological surgery, and explore the relationship between shared decision making and patient reported surgeon ranking.

This study uses Consumer Assessment of Healthcare Provider and Systems Surgical Care Survey data from patients undergoing urological surgery between 2011 and 2013. A shared decision making composite score was created from the sum of 3 survey items. We fit an ordinal logistic regression model to evaluate factors that influence patients' overall shared decision making score. In a separate model, we evaluated how shared decision making and use of decision aid impact patients' ranking of surgeons.

In this sample, 430 (33.8%) surveys were returned. Of respondents, 71% scored maximum points on the shared decision making composite score and 59% reported that their surgeon used a decision aid. Discussing alternative treatment options was the most often omitted step in shared decision making. Patients who report use of a decision aid had nearly double the odds of self-reported shared decision making (OR 1.84, 95% CI 1.10-3.06, p=0.02). Shared decision making or decision aid use was not associated with patient reported surgeon ranking.

The majority of patients reported shared decision making and decision aid use during preoperative counseling. Patients reporting decision aid use had nearly double the odds of reporting shared decision making. There was no correlation between either shared decision making or decision aid use and patients' ranking of their surgeon.