Shared Decision Making and Choice for Elective Surgical Care: A Systematic Review

Shared decision making (SDM), an integrative patient-provider communication process emphasizing discussion of scientific evidence and patient/family values, may improve quality care delivery, promote evidence-based practice, and reduce overuse of surgical care. Little is known, however, regarding SD...

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Bibliographic Details
Published in:Otolaryngology-head and neck surgery Vol. 154; no. 3; p. 405
Main Authors: Boss, Emily F, Mehta, Nishchay, Nagarajan, Neeraja, Links, Anne, Benke, James R, Berger, Zackary, Espinel, Ali, Meier, Jeremy, Lipstein, Ellen A
Format: Journal Article
Language:English
Published: England 01.03.2016
Subjects:
Choice Behavior
Decision Making
Decision Support Techniques
Elective Surgical Procedures
Humans
elective surgery
decision support tool
decision aid
systematic review
shared decision-making
informed decision making
ISSN:1097-6817, 1097-6817
Online Access:Get more information
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Summary:Shared decision making (SDM), an integrative patient-provider communication process emphasizing discussion of scientific evidence and patient/family values, may improve quality care delivery, promote evidence-based practice, and reduce overuse of surgical care. Little is known, however, regarding SDM in elective surgical practice. The purpose of this systematic review is to synthesize findings of studies evaluating use and outcomes of SDM in elective surgery. PubMed, Cochrane CENTRAL, EMBASE, CINAHL, and SCOPUS electronic databases. We searched for English-language studies (January 1, 1990, to August 9, 2015) evaluating use of SDM in elective surgical care where choice for surgery could be ascertained. Identified studies were independently screened by 2 reviewers in stages of title/abstract and full-text review. We abstracted data related to population, study design, clinical dilemma, use of SDM, outcomes, treatment choice, and bias. Of 10,929 identified articles, 24 met inclusion criteria. The most common area studied was spine (7 of 24), followed by joint (5 of 24) and gynecologic surgery (4 of 24). Twenty studies used decision aids or support tools, including modalities that were multimedia/video (13 of 20), written (3 of 20), or personal coaching (4 of 20). Effect of SDM on preference for surgery was mixed across studies, showing a decrease in surgery (9 of 24), no difference (8 of 24), or an increase (1 of 24). SDM tended to improve decision quality (3 of 3) as well as knowledge or preparation (4 of 6) while decreasing decision conflict (4 of 6). SDM reduces decision conflict and improves decision quality for patients making choices about elective surgery. While net findings show that SDM may influence patients to choose surgery less often, the impact of SDM on surgical utilization cannot be clearly ascertained.
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ISSN:1097-6817
1097-6817
DOI:10.1177/0194599815620558