Shared decision-making within acute care surgery and surgical residency: Identifying deficiencies to increase use.

Abstract

Shared decision-making is integral to patient-centered, goal concordant health care. In this model clinicians and patients work together to make care plans balancing clinical evidence regarding risks, benefits, and expected outcomes with patient preferences and values. While this is an ideal approach to patient care shared decision-making is inconsistently applied. Our aim was to identify surgery attendings', fellows', and residents' perceived barriers to, comfort with, and training experience in shared decision-making. Surgery attendings (attendings/fellows) and residents across a health care market were surveyed regarding perceived barriers towards performing shared decision-making (August-October 2023). Provider demographics, perceived patient/family and time barriers, as well as surgeon comfort in utilizing shared decision-making were queried using a 5-point Likert scale. The survey was administered via REDCap and results were compared between resident and attending (fellow/attending) physicians. Univariate analysis was used to compare the difference between groups. Over the survey period 40 residents and 44 attendings responded (53% response). Residents were more likely to have had prior shared decision-making simulation-based education (P = .002). Significant barriers to residents using shared decision-making included lack of time (P = .01) and the fear of being perceived as being less knowledgeable when discussing different treatment options (P < .0001) compared to attending physicians. Residents were less comfortable in discussing "Big Picture" prognosis (P < .0001), addressing unrealistic patient/family expectations (P = .01), and clarifying patient preferences (P = .04) compared with attendings. While multiple barriers to shared decision-making were identified, the greatest need for further training was noted in the resident responses. Future training for residents should focus on the identified barriers toward implementing shared decision-making.