Decision-Making in Surgery.

Area of Science:

• Medical Ethics
• Surgical Communication
• Patient-Centered Care

Background:

• Cardiothoracic surgery involves high-stakes, rapid decisions, often with limited prior patient relationships.
• Effective communication is vital for informed consent and navigating complex postoperative scenarios.

Purpose of the Study:

• To review challenges in preoperative and postoperative decision-making and communication in cardiothoracic surgery.
• To explore shared decision-making as the preferred method for informed consent.
• To provide strategies for optimizing surgeon communication and patient/family engagement.

Main Methods:

• Literature review of ethical and legal requirements for informed consent.
• Analysis of decision-making challenges in high-risk surgery for older patients with serious illness.
• Exploration of concepts like clinical heroism and futility in surgical outcomes communication.

Main Results:

• Shared decision-making is the contemporary standard for informed consent.
• Postoperative decisions often involve surrogate decision-makers when patients lose capacity.
• Effective communication strategies are needed to address patient discontent and ensure goal-concordant care.

Conclusions:

• Surgeons must enhance communication skills to improve patient and family engagement.
• Addressing ethical challenges in perioperative decision-making is essential for optimal patient care.
• Frameworks for communication can support high-risk surgical scenarios, especially for vulnerable populations.