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

Area of Science:

• Medical Sociology
• Health Psychology
• Surgical Decision-Making Research

Background:

• Complex surgery decisions are critical patient junctures.
• Shared decision-making (SDM) aims to align patient and clinician goals.
• Current SDM models may not fully capture patient complexity.

Purpose of the Study:

• To investigate patient approaches to complex surgical decisions.
• To identify opportunities for improving clinical discussions and SDM.

Main Methods:

• Qualitative study utilizing semi-structured interviews.
• Focus on patients recently undergoing complex surgery.
• Analysis via reflexive thematic analysis for decision-making patterns.

Main Results:

• Five domains shape patient decisions: clinician interactions, clinical situation, social context, values/identity/quality of life, and emotional experiences.
• Significant patient variation exists in engaging these domains and desired decision-making roles.
• Communication style and relational contexts (e.g., with partners) are crucial; decisions align with personal quality of life and identity.

Conclusions:

• Surgical decision-making is a complex, individualized process extending beyond the clinic.
• Information-centric SDM approaches may be insufficient.
• Integrating patient context (communication, relationships, quality of life) can enhance SDM in surgical practice.