Patient perspectives of shared decision-making in emergency surgery

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Colorectal Disease Pub Date : 2025-01-23 DOI:10.1111/codi.70000

Rachel Spence, Susan Joan Moug, Meghan Minnis, Attika Chaudhary, Mairi Docherty, Sherzah Jamal, Shona MacTavish, Carly Nichola Bisset

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Abstract

Aim

Shared decision-making (SDM) is now considered the gold standard approach to counselling and obtaining patient consent. Research into patient perceptions of SDM is lacking and barriers to its implementation remain, specifically in the time-pressurized, high-risk emergency general surgery (EGS) setting. The aim of this work was to explore what EGS patients understand about SDM, gaining insight into their perspectives and experiences to understand the potential barriers both clinicians and patients may face.

Method

This work consisted of two parts: part 1 was an initial scoping review to inform the development of part 2—a patient and public involvement (PPI) exercise. The scoping review determined the quantity and quality of research in this area enabling long-listing of known SDM concepts. This long-list developed questions and structured discussions for the PPI exercise. Responses were transcribed, then analysed using thematic analysis.

Results

The scoping review found limited evidence for both the implementation of SDM in EGS and patients' perspectives. Seven papers considered SDM in other settings that allowed long-listing of the values and concepts for the PPI exercise. Nine patients and four supporters were identified from an established EGS database. After open discussion of the values and SDM concepts, thematic analysis was performed that identified two key themes: patient perceptions of how surgeons make decisions, and patient experiences of EGS decision-making. Five subtheme analyses showed participants were not aware of surgeons' use of ‘30-day mortality’ and could not quantify surgical risk, feeling time pressures and out of control. Almost all relied on surgeons to make their decision, valuing the surgeon's opinion over their own.

Conclusion

With no previous reported evidence, this work provides the first patient insights into SDM in the EGS setting. With multiple barriers identified, further work is essential to increase implementation of this gold standard approach to patient consent.

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急诊手术中共同决策的患者观点。

目的：共同决策（SDM）现在被认为是咨询和获得患者同意的黄金标准方法。缺乏对患者对SDM的认知的研究，实施SDM的障碍仍然存在，特别是在时间紧迫、高风险的急诊普通外科（EGS）环境中。这项工作的目的是探索EGS患者对SDM的理解，深入了解他们的观点和经验，以了解临床医生和患者可能面临的潜在障碍。方法：这项工作由两部分组成：第一部分是初步的范围审查，为第二部分的发展提供信息——患者和公众参与（PPI）活动。范围审查确定了这一领域研究的数量和质量，从而能够列出已知SDM概念的长列表。这份长长的清单为PPI实践提出了问题并组织了讨论。对回答进行转录，然后使用主题分析进行分析。结果：范围综述发现，在EGS和患者角度实施SDM的证据有限。七篇论文考虑了SDM在其他环境中的应用，这些环境允许长时间列出PPI的值和概念。从已建立的EGS数据库中确定了9名患者和4名支持者。在对价值和SDM概念进行公开讨论后，进行了主题分析，确定了两个关键主题：患者对外科医生如何决策的看法，以及患者对EGS决策的体验。五个次级主题分析显示，参与者不知道外科医生使用“30天死亡率”，也无法量化手术风险，感到时间压力和失控。几乎所有人都依赖外科医生来做决定，重视外科医生的意见而不是自己的意见。结论：在没有先前报道的证据的情况下，这项工作首次为EGS环境下的SDM患者提供了见解。由于确定了多种障碍，必须进一步开展工作，以加强实施这一患者同意的黄金标准方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Colorectal Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

11.80%

发文量

406

审稿时长

1.5 months

期刊介绍： Diseases of the colon and rectum are common and offer a number of exciting challenges. Clinical, diagnostic and basic science research is expanding rapidly. There is increasing demand from purchasers of health care and patients for clinicians to keep abreast of the latest research and developments, and to translate these into routine practice. Technological advances in diagnosis, surgical technique, new pharmaceuticals, molecular genetics and other basic sciences have transformed many aspects of how these diseases are managed. Such progress will accelerate. Colorectal Disease offers a real benefit to subscribers and authors. It is first and foremost a vehicle for publishing original research relating to the demanding, rapidly expanding field of colorectal diseases. Essential for surgeons, pathologists, oncologists, gastroenterologists and health professionals caring for patients with a disease of the lower GI tract, Colorectal Disease furthers education and inter-professional development by including regular review articles and discussions of current controversies. Note that the journal does not usually accept paediatric surgical papers.