Over One-Third of Surgical Patients Report Inadequate Shared Decision-Making: Opportunities for Improvement From the ACS NSQIP PROMs Project.

Abstract

This study aimed to identify patient, surgeon, and hospital characteristics associated with inadequate shared decision-making (SDM) after surgery. SDM that incorporates patients' preferences, values, and goals is integral to setting expectations and delivering high-quality patient-centered surgical care. This retrospective cohort study of 65 US hospitals analyzed data from the American College of Surgeons National Surgical Quality Improvement Program Patient-Reported Outcomes Measures Project. Multilevel logistic regression incorporating available patient, surgeon, and hospital characteristics modeled inadequate SDM as measured by 2 validated patient-reported SDM measures: CollaboRATE and the SDM-Q-9. Across 30,957 patients and 2921 surgeons, 36.5% (CollaboRATE: 11226/30957) to 57.7% (SDM-Q-9: 16358/28363) of patients reported inadequate SDM. Upon multivariable analysis, inadequate SDM was significantly associated with postoperative complications, Medicaid or Medicare coverage relative to commercial insurance, and having nonambulatory procedures. Further, patients were more likely to report inadequate SDM if their surgeons were male and in either Orthopedic Surgery, Urology, or Vascular Surgery, relative to General Surgery. Patients cared for at Rural Referral Centers were also more likely to report inadequate SDM. SDM is an essential component of high-quality, patient-centered care, yet this study identified that over a third of surgical patients reported inadequate SDM. Attention paid to improving SDM is critical, as SDM is not only a priority for patients and families but also may soon become a national quality performance standard.