Wouter Leclercq

Shared decision making and surgical informed consent in general surgery: A pilot study on differences in perspectives of physicians and patients 109 7 INTRODUCTION In the past it was generally accepted ‘standard of care’ that a physician defined most (if not all) details of the client’s treatment regimen. More recently, the patient’s active role in this treatment process is increasingly acknowledged. In a physician-patient partnership, preferences and available treatment options should openly be discussed. 1,2 ‘Shared decision making’ (SDM) is a widely accepted concept that is considered pivotal for good clinical practice. 3-5 SDM is intuitively appealing and may possibly lead to an improved therapeutic outcome. 2-5 A smooth introduction of SDM in standard surgical patient care is challenging. 4 Questionnaires may aid in evaluating the roles of both patient and care provider during a consultation. Recently, a nine-item SDM-Questionnaire (SDM-Q-9) assessing a patient’s role demonstrated good psychometric characteristics including internal consistency, item discriminations, and face and factorial validity scores. 1 A physician version (SDM-Q- Doc) followed in suit. 5 A Dutch version of both questionnaires was found to have good acceptance and reliability in a study among general practitioners and medical specialists. 3 The informed consent process in surgery is another aspect that is increasingly recognized as important in the physician-patient relationship (Figure 7.1). It is thought that a proper completion of all three stages (preconditions, information and consent) of a surgical informed consent (SIC) procedure also depends on SDM. In other words, SIC is destined to fail if both partners are unaware of the mechanisms that play a role in SDM. Both SIC and SDM processes share certain items. However, SIC has a legal focus whereas SDM is aimed at perspectives of the decision process. Physicians must monitor both processes during a consultation as neglecting either SDM or SIC may result in suboptimal treatment results and dissatisfied patients. A number of recent studies found that completion of the SIC process in general surgery, orthopaedic-, as well as plastic surgery was suboptimal. 6,7 These findings suggest that improvement of SDM may also lead to improved quality of the SIC process. Goal of this pilot study was to test the quality of, and relation between SDM and SIC in a Dutch general surgery outpatient department using the SDM-Q-9, SDM-Q-Doc questionnaires and a SIC rating scale. If there is a strong correlation between these SDM and SIC measures, SDM questionnaires might be used as a tool or outcome parameter in SIC studies.