Patient perspectives on the decision-making process before complex surgery: A qualitative study

To examine how patients approach the decision to undergo complex surgery and explore opportunities to better align clinical discussions with these processes to support shared decision-making (SDM).

We conducted a qualitative study using semi-structured interviews with patients who had recently undergone complex surgery. Interviews explored patients' experiences with presurgical decision-making. Data were analyzed using reflexive thematic analysis to identify patterns in how patients approached and navigated decisions.

Five interrelated domains characterized the patient-specific decisional context through which patients understood, experienced, and navigated decisions about complex surgery: 1) clinician interactions, 2) the clinical situation and surgical stakes, 3) social and relational context, 4) values, identity, and quality of life, and 5) emotional and psychological experiences. While these domains were consistent across participants, there was substantial variation in how patients engaged within each domain, including differences in desired roles in decision-making. Patients emphasized the importance of how clinicians communicated and decision-making was frequently embedded within relational contexts, particularly involving spouses or significant others. Decisions were also guided by individualized definitions of quality of life that were closely linked to identity and lived priorities, with patients evaluating surgical options based on what made life meaningful to them.

Decision-making related to complex surgery is a multidimensional and highly individualized process that reflects factors both within and beyond the clinical encounter. Current approaches to SDM that prioritize information exchange alone may be insufficient to support how patients experience and navigate complex surgical decisions.

Efforts to strengthen SDM in surgery may benefit from approaches that elicit and integrate patient-specific contextual factors, including communication preferences, relational dynamics, and individualized definitions of quality of life, in ways that align with the workflow of surgical practice.