Conceptual model of multidisciplinary shared decision-making for high-risk surgical patients: a Delphi study

High-risk patients need to carefully consider the risks and benefits of surgery. Shared decision-making is a collaborative process that enables patients and clinicians to share information and weigh up options and preferences. There is limited evidence about how best to organise the participation of the full range of healthcare professionals who can contribute to such decision-making processes. We conducted a Delphi study with a panel of experts to clarify how, and for what purposes, different healthcare professionals can contribute to shared decision-making with high-risk surgical patients. Consensus was reached on a conceptual model of multidisciplinary shared decision-making. The model recommends that interactions between patients, supported by family members and informal carers, and healthcare professionals are organised around five areas: options for management and treatment; patient values, goals, and preferences; comprehensive needs assessment; social context and home environment; and perioperative preparations. Experts agreed that achieving multidisciplinary shared decision-making in practice requires four key facilitators: early identification of patients with complex decision-making needs, availability of specialist expertise and support, sufficient time for discussion and decision-making, and coordination and information sharing between interactions. This model organises multidisciplinary involvement in high-risk surgical shared decision-making into five conceptually distinct and operationally interdependent areas. The model has the potential to inform practice and enhance opportunities for shared decision-making for high-risk surgical patients and their multidisciplinary teams.