Wouter Leclercq

Shared decision making and surgical informed consent in general surgery: A pilot study on differences in perspectives of physicians and patients 111 7 METHODS General study information This pilot study was performed between April and November 2014 at the surgical outpatient department of Máxima Medical Center (MMC), Veldhoven, the Netherlands. MMC is a 595-bed teaching hospital located in the south-eastern part of the country. Approval of the medical ethics board of MMC was requested but deemed unnecessary as it was judged by MMC’s ethics board that the questionnaires only required a very limited amount of extra time and effort by the patients and did not interfere with daily practice. Outpatient consultation A random subset of MMC surgical surgeons (general, vascular, oncology, trauma; total n=13) working in a team of 29 professionals (surgeons, n=15; residents, n=14) were asked to participate. If a surgeon agreed, he was asked to thoroughly read both the SDM-Q-9 and SDM-Q-Doc questionnaires but extra background information or additional teaching was not provided. He was instructed to inform a patient as usual on details of a pending operative procedure during an outpatient department consultation. He was also asked to complete the SIC process according to his professional standard. Details of the consultation were documented in the electronic patient dossier (EPD; EZIS Chipsoft, Amsterdam). A basic SIC module in this EPD allowed tabulation of notes on three aspects of SIC including the discussion of frequently occurring or major potential complications and alternative treatment options. A nurse informed patients who were scheduled for preoperative consultation in the surgical outpatient department regarding specifics of the study and requested consent to participate. Once the consultation with the surgeon was finished and the patient had left the room, the surgeon completed a paper version of the SDM-Q-Doc. The patient completed a paper version of the SDM-Q-9 in a separate room. Both questionnaires usually required less than 5 minutes to finish. SDM-Q-Doc, SDM-Q-9 and SIC The SDM-Q-9 and SDM-Q-Doc questionnaires measure patient and physician perception of extent and quality of SDM during a physician-patient-consultation (Table 7.1). 3 Both include two open questions (‘what is the reason for consultation’, ‘which decision is made’) and 9 multiple choice questions. Each of these 9 questions is scored on a six- point Likert scale (range, 0 totally disagree to 5, totally agree). As a consequence, a total questionnaire score ranges from 0 to 45. Scores are converted into a 0 (low SDM) to 100 (excellent SDM) range as reported. 1-5