Wouter Leclercq

Shared decision making and surgical informed consent in general surgery: A pilot study on differences in perspectives of physicians and patients 117 7 DISCUSSION Shared decision making (SDM) and surgical informed consent (SIC) are increasingly recognized as important aspects of preoperative consultation in general surgery. Aim of this study was to assess the potential use of SDM-Q-9 and SDM-Q-Doc in SIC related research. Very few studies investigated the applicability of these tools in general surgery. To our knowledge this is the first study analysing SDM-Q-9, SDM-Q-DOC in relation to SIC recording in the EPD. The current SDM-Q-9 scores were higher than expected. Based on a previous Dutch study, a SDM-Q-9/Doc score around 75 was anticipated in the present pilot. 3 However, a mean SDM-Q-9 score of 85 was attained, a score that was also higher compared to the original study from Kriston and Scholl. Another recent study of Santema also reported a much higher score (Table 7.3). 1,4-5 A possible explanation of these higher scores in the present study and that of Santema may be the clinical setting when compared to the general practice setting of the Kriston and Scholl studies. Surely, treatment options that were selected by these patients were in line with their expectation after the consultation in the general practice setting as a surgical procedure is necessary. As SDM-Q-9 scores were almost at maximum level in this and other clinical studies, this tool is not discriminative and is not recommended in clinical studies. In the present study, surgeons scored their consultations at a lower SDM level compared to their patients (Table 7.4) . In literature, scores of doctors and patients vary widely (Table 7.3) . In this study, the items ‘pros and cons of surgery’, ‘checking if provided information is understood by the patient’, and ‘reflecting on the patients’ choice differed significantly between patients and physicians (Table 7.4). The lower scores of surgeons may reflect a basic uncertainty regarding these issues. A more recent study by Geessink showed a higher SDM level perceived by patients in comparison to that perceived by observers. 8 They suggested that patients may have difficulties to distinguish between the constructs of involvement and satisfaction. In our study, this may have led to an overestimation of the level of involvement by the patients. Interestingly, SDM items that differed between patients and surgeons are also key items in SIC (Table 7.1 and 7.2). Previous studies already showed high subjective SIC-scores but low objective SIC-scores. An equal observation recently was made in SDM. 4 Therefore we speculate that enhancing focus on SDM will enhance the SIC process and vice versa and possibly may enhance satisfaction for patients and surgeons.