Impact of Shared Decision Making on Elective Surgery

A systematic review of the literature found that shared decision making reduces conflict and improves the quality of the decision for patients who are making choices about elective surgery. Specifically, the study found that shared decision making may influence patients to choose elective surgeries less often (Otolaryngol Head Neck Surg. 2016;154:405-420).

Shared decision making, a communication process that emphasizes discussion between clinicians and their patients of all treatment alternatives in the context of patient/family values, has been proposed as a strategy to reduce overuse of surgical care. Little data is available on the impact of shared decision making on elective surgical practice.

To fill this gap, Emily Boss, MD, with the Johns Hopkins University School of Medicine and Bloomberg School of Public Health in Baltimore, and her colleagues, performed a systematic review of the literature of studies published between January 1990 and August 2015 in which elective surgical care could be ascertained. Of the 10,929 studies identified, 24 met inclusion criteria of elective surgeries (seven in the spine, five in joints, and four in gynecology) and 20 studies included used decision aids or support tools (13 used multimedia/video, three used written tools, and four used personal coaching).

The report found that the effect of shared decision making on the preference for surgery was mixed across the studies, but did find that shared decision making tended to improve decision quality, knowledge, and preparation while reducing decision conflict.

The impact of shared decision making on elective surgery for children is more vague, said the authors, as only two studies focusing on children met study inclusion.

Dr. Boss emphasized that these findings may be particularly relevant to otolaryngologists given the high proportion of elective surgical cases in otolaryngology. “As such, physicians should share information regarding all treatment alternatives wholly and transparently with families to ensure that parents can make a decision that is right for their child,” she said.