Shared Decision Making and Choice for Elective Surgical Care: A Systematic Review

Emily F Boss; Nishchay Mehta; Neeraja Nagarajan; Anne Links; James R Benke; Zackary Berger; Ali Espinel; Jeremy Meier; Ellen A Lipstein

doi:10.1177/0194599815620558

Shared Decision Making and Choice for Elective Surgical Care: A Systematic Review

Otolaryngol Head Neck Surg. 2016 Mar;154(3):405-20. doi: 10.1177/0194599815620558. Epub 2015 Dec 8.

Authors

Emily F Boss¹, Nishchay Mehta², Neeraja Nagarajan³, Anne Links⁴, James R Benke⁴, Zackary Berger⁵, Ali Espinel⁶, Jeremy Meier⁶, Ellen A Lipstein⁷

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Erudnic2@jhmi.edu.
² evidENT, Ear Institute, University College London, London, UK.
³ Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
⁴ Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
⁵ Division of General Internal Medicine, Johns Hopkins School of Medicine; Department of Health, Behavior, and Society, Johns Hopkins University School of Public Health; Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland, USA.
⁶ Department of Otolaryngology, Children's National Health System, Washington, DC, USA.
⁷ Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA.

Abstract

Objective: Shared decision making (SDM), an integrative patient-provider communication process emphasizing discussion of scientific evidence and patient/family values, may improve quality care delivery, promote evidence-based practice, and reduce overuse of surgical care. Little is known, however, regarding SDM in elective surgical practice. The purpose of this systematic review is to synthesize findings of studies evaluating use and outcomes of SDM in elective surgery.

Data sources: PubMed, Cochrane CENTRAL, EMBASE, CINAHL, and SCOPUS electronic databases.

Review methods: We searched for English-language studies (January 1, 1990, to August 9, 2015) evaluating use of SDM in elective surgical care where choice for surgery could be ascertained. Identified studies were independently screened by 2 reviewers in stages of title/abstract and full-text review. We abstracted data related to population, study design, clinical dilemma, use of SDM, outcomes, treatment choice, and bias.

Results: Of 10,929 identified articles, 24 met inclusion criteria. The most common area studied was spine (7 of 24), followed by joint (5 of 24) and gynecologic surgery (4 of 24). Twenty studies used decision aids or support tools, including modalities that were multimedia/video (13 of 20), written (3 of 20), or personal coaching (4 of 20). Effect of SDM on preference for surgery was mixed across studies, showing a decrease in surgery (9 of 24), no difference (8 of 24), or an increase (1 of 24). SDM tended to improve decision quality (3 of 3) as well as knowledge or preparation (4 of 6) while decreasing decision conflict (4 of 6).

Conclusion: SDM reduces decision conflict and improves decision quality for patients making choices about elective surgery. While net findings show that SDM may influence patients to choose surgery less often, the impact of SDM on surgical utilization cannot be clearly ascertained.

Keywords: decision aid; decision support tool; elective surgery; informed decision making; shared decision-making; systematic review.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
Review
Systematic Review

MeSH terms

Choice Behavior*
Decision Making*
Decision Support Techniques
Elective Surgical Procedures*
Humans

Abstract

Publication types

MeSH terms

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