Qualitative perspectives on shared decision-making from general surgery faculty and trainees

Abstract

PurposeDespite the merits of shared decision making (SDM), it remains underused in surgical fields. Through individual semi-structured interviews with general surgery providers, we explored how surgeons and surgeons-in-training perceive and engage in SDM at our academic safety-net hospital and investigated ways to increase SDM use within our surgical department.MethodsWe developed and administered individual semi-structured interviews to general surgery faculty and residents at our institution to explore their SDM knowledge and attitudes and identify actionable ways to promote SDM in surgery. Their responses were analyzed using inductive content analysis.ResultsProviders expressed positive opinions of SDM, though they also described ambivalence regarding how patients perceive SDM and the role of patients’ families in SDM. Providers identified various barriers to SDM, including time limitations, specific clinical scenarios, and patient-specific factors such as language barriers and socioeconomic status. Providers further elaborated that difficulty communicating their medical knowledge to patients also posed a barrier to SDM.ConclusionsGeneral surgery faculty and residents at our institution have a positive view of SDM. Our findings demonstrated opportunities for provider education on involving patients’ families in SDM and utilizing decision aids, as well as institutional interventions to mitigate barriers posed by language differences, socioeconomic status, and time limitations. Participant responses also suggested areas for further research on the impact of SDM on the patient-provider relationship and adaptation of SDM to patients who prefer greater physician involvement in decision-making.