Surgeon Perspectives on Decisional Antecedents in Preoperative Decision-Making

Shared decision-making (SDM) is widely endorsed in surgical care, yet it is inconsistently applied. A lack of attention to decisional antecedents, including patients' beliefs, goals, experiences, emotions, and social context, may contribute to this gap, particularly in time-constrained preoperative settings. The current study sought to characterize surgeon perspectives on decisional antecedents and identify opportunities to strengthen SDM within routine surgical workflows.

In-depth, semistructured interviews were conducted with surgeons at a single academic medical center. Surgeons were identified through departmental faculty lists and invited by email. Interviews were conducted via Zoom, transcribed verbatim, and analyzed thematically in NVivo using an inductive approach. Two team members independently coded transcripts and developed themes through iterative discussion.

Eighteen surgeons from six subspecialties participated. Five themes characterized how surgeons approached SDM in preoperative consultations: (1) variability in patient engagement, (2) role of decisional antecedents, (3) time and cognitive constraints, (4) value of pre-encounter context, and (5) third parties reveal patient values. Surgeons reported that patients differ widely in their readiness, informational needs, prior experiences, and desired involvement, yet this information was often not available to them because routine workflows provided few opportunities to uncover it. Surgeons viewed decisional antecedents and third-party perspectives (e.g., family, caregivers) as central to SDM but reported structural barriers to incorporate these factors during time-limited consultations.

Pre-visit strategies are needed to surface key contextual factors to support SDM within existing surgical workflows.