Measuring critical deficits in shared decision making before elective surgery

Claire K Ankuda; Susan D Block; Zara Cooper; Darin J Correll; David L Hepner; Morana Lasic; Atul A Gawande; Angela M Bader

doi:10.1016/j.pec.2013.11.013

Measuring critical deficits in shared decision making before elective surgery

Patient Educ Couns. 2014 Mar;94(3):328-33. doi: 10.1016/j.pec.2013.11.013. Epub 2013 Dec 11.

Authors

Claire K Ankuda¹, Susan D Block², Zara Cooper³, Darin J Correll⁴, David L Hepner⁴, Morana Lasic⁴, Atul A Gawande⁵, Angela M Bader⁶

Affiliations

¹ Department of Family Medicine, University of Washington, Seattle, USA.
² Department of Psychiatry, Harvard Medical School, USA; Department of Medicine, Harvard Medical School, USA; Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, USA.
³ Harvard Medical School, Department of Surgery, Brigham and Women's Hospital, Boston, USA.
⁴ Harvard Medical School, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, USA.
⁵ Harvard Medical School, USA; Department of Health Policy and Management, Harvard School of Public Health, USA; Department of Surgery, Brigham and Women's Hospital, Boston, USA.
⁶ Harvard Medical School, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, USA. Electronic address: abader@partners.org.

PMID: 24382399
DOI: 10.1016/j.pec.2013.11.013

Abstract

Objective: Identifying patient factors correlated with specific needs in preoperative decision making is of clinical and ethical importance. We examined patterns and predictors of deficiencies in informed surgical consent and shared decision-making in preoperative patients.

Methods: Validated measures were used to survey 1034 preoperative patients in the preoperative clinic after signed informed consent. Principal component analysis defined correlated groupings of factors. Multivariable analysis assessed patient factors associated with resultant groupings.

Results: 13% of patients exhibited deficits in their informed consent process; 33% exhibited other types of deficits. Informed consent deficits included not knowing the procedure being performed or risks and benefits. Other deficits included not having addressed patient values, preferences and goals. Non-English language and lower educational level were factors correlated with higher risk for deficits.

Conclusion: Deficits exist in over a third of patients undergoing preoperative decision-making. Sociodemographic factors such as language and educational level identified particularly vulnerable groups at risk for having an incomplete, and possibly ineffective, decision-making process.

Practice implications: Interventions to identify vulnerable groups and address patient centered surgical decision making in the pre-operative setting are needed. Focused interventions to address the needs of at-risk patients have potential to improve the surgical decision-making process and reduce disparities.

Keywords: Health care disparities; Shared surgical decision making.

MeSH terms

Adult
Aged
Decision Making*
Decision Support Techniques
Educational Status
Elective Surgical Procedures*
Female
Health Care Surveys
Healthcare Disparities
Humans
Informed Consent*
Logistic Models
Male
Middle Aged
Patient Participation / methods*
Physician-Patient Relations
Principal Component Analysis
Process Assessment, Health Care