Abstract
BackgroundShared decision-making (SDM) seeks to involve both patients and clinicians in decision-making about possible health management strategies, using patients’ preferences and best available evidence. SDM seems readily applicable in anesthesiology.We aimed to determine the current level of SDM among preoperative patients and anesthesiology clinicians.MethodsWe invited 115 consecutive preoperative patients, visiting the pre-assessment outpatient clinic of the department of Anesthesiology at the Academic Medical Center of Amsterdam. Inclusion criteria were patients who needed surgery in the arms, lower abdomen or legs, and in whom three anesthesia techniques were feasible. The SDM-level of the consultation was scored objectively by independent observers who judged audio-recordings of the consultation using the OPTION5-scale, ranging from 0% (no SDM) to 100% (optimum SDM), as well as subjectively by patients (using the SDM-Q-9 and CollaboRATE questionnaires) and clinicians (SDM-Q-Doc questionnaire). Objective and subjective SDM-levels were assessed on five-point and six-point Likert scales, respectively. Both scores were expressed as percentages.ResultsData of 80 patients could be analysed. Objective SDM-scores were low (30.5%). Subjective scores of the SDM-Q-9 and CollaboRATE were high among patients (91.7% and 96.3%, respectively) and among clinicians (SDM-Q-Doc; 84.3%). Apparently, they appreciated satisfaction rather than SDM, being poorly aware of what SDM entails.ConclusionThe level of SDM in an outpatient anesthesiology clinic where preoperative patients receive information about various possible anesthesia options, was found to be low. Thus, there is room for improving the level of SDM. Some suggestions are given how this can be achieved.
Highlights
Shared decision-making (SDM) seeks to involve both patients and clinicians in decision-making about possible health management strategies, using patients’ preferences and best available evidence
The consultations had a mean duration of 12 min and ranged from 1.3 to 24.3 mins. This duration was not significantly related to the SDMQ-9, SDM-Q-doc, Collaborate scores, or the clinicians’ background, but a significant positive association was found between the conversation duration and the OPTION score (p = 0.001), as well as a small but significant association with the patient’s age (p = 0.03)
SDM-Q-9, SDM-Q-doc and CollaboRATE scores per clinician We found an intra-class correlation coefficients (ICC) of 0.16 between caregivers and OPTION5-scores and an ICC of 0.06 between caregivers and SDM-Q-9 scores, indicating that the variance was mainly due to differences among patients, rather than among caregivers
Summary
Shared decision-making (SDM) seeks to involve both patients and clinicians in decision-making about possible health management strategies, using patients’ preferences and best available evidence. We aimed to determine the current level of SDM among preoperative patients and anesthesiology clinicians. Shared decision-making (SDM) is the process in which healthcare providers and patients decide together about the preferred treatment choice when more than one treatment option is available, using the best available evidence [1, 2]. SDM is one of the three pillars in the definition of evidence-based medicine [3]. The principle of evidence-based medicine has been widely accepted and includes appreciation of the situation and preference of the patient. There are several arguments that favour the application of SDM in various specialties. Research has shown that patients usually desire a more active role in decision-making [9, 10]
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