Using CollaboRATE to Characterize Surgeon-Level Shared Decision-Making Performance

Area of Science:

• Surgical quality improvement
• Patient-centered care

Background:

• Shared decision-making (SDM) improves surgical outcomes by aligning care with patient values.
• Assessing SDM variation among surgeons is crucial for quality improvement.

Purpose of the Study:

• To characterize the variation in shared decision-making (SDM) levels among surgeons.
• To identify factors associated with surgeon-level SDM performance using patient-reported data.

Main Methods:

• Retrospective cohort study of 30,957 surgical patients and 2,921 surgeons (2020-2023).
• Analysis of American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Patient-Reported Outcomes (PRO) data.
• Multilevel logistic regression to identify factors associated with SDM performance.

Main Results:

• 64% of patients reported adequate SDM (score of 27).
• Only 1.2% of surgeons achieved optimal mean scores, while 80.6% met the median.
• Lower performance linked to male gender, cardiothoracic specialty, rural practice, and >31 years of experience.

Conclusions:

• CollaboRATE data reveals significant surgeon-level variability in SDM.
• SDM appears to be a modifiable skill, suggesting a need for targeted surgeon training and quality improvement initiatives.