Defining and Ensuring Multidisciplinary High-Quality Patient-Centered Shared Decision-Making for Procedures: a Brief Review of the Current State

Abstract

Defining and ensuring the quality of surgical decision making is extremely complex. This manuscript will provide a review of current state in this evolving area and a conceptual framework to help clinicians understand how to approach this issue. Recent reports support the hypothesis of the existence of significant decisional deficits. There are a number of factors identified that contribute to this: among these are lack of adequate metrics to define decisional quality, lack of training in this area for providers, and lack of compensation for the additional time it might take. A conceptual framework can assist the clinician having these discussions. The importance of decisional quality is increasingly being recognized. As we strive in the current health care environment to provide the right procedure for the right patient, ensuring the elimination of unnecessary and unwanted care that is not aligned with patient values and goals will become even more important. The constrained economics of health care and the increasing desire for patient advocacy, engagement, and high-quality communication with care givers lend support to this work.