How surgeons use risk calculators and non-clinical factors for informed consent and shared decision making: A qualitative study

Jasmine Panton; Brendin R Beaulieu-Jones; Jayson S Marwaha; Alison P Woods; Drashko Nakikj; Nils Gehlenborg; Gabriel A Brat

doi:10.1016/j.amjsurg.2023.07.017

How surgeons use risk calculators and non-clinical factors for informed consent and shared decision making: A qualitative study

Am J Surg. 2023 Nov;226(5):660-667. doi: 10.1016/j.amjsurg.2023.07.017. Epub 2023 Jul 11.

Authors

Jasmine Panton¹, Brendin R Beaulieu-Jones², Jayson S Marwaha², Alison P Woods³, Drashko Nakikj⁴, Nils Gehlenborg⁴, Gabriel A Brat⁵

Affiliations

¹ Geisel School of Medicine at Dartmouth, Hanover, NH, USA; Department of Surgery, Beth Israel Deaconess Medical Center (BIDMC), Boston, MA, USA.
² Department of Surgery, Beth Israel Deaconess Medical Center (BIDMC), Boston, MA, USA; Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA.
³ Department of Surgery, Beth Israel Deaconess Medical Center (BIDMC), Boston, MA, USA; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁴ Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA.
⁵ Department of Surgery, Beth Israel Deaconess Medical Center (BIDMC), Boston, MA, USA; Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA. Electronic address: gbrat@bidmc.harvard.edu.

PMID: 37468387
PMCID: PMC10592325 (available on 2024-11-01)
DOI: 10.1016/j.amjsurg.2023.07.017

Abstract

Background: The discussion of risks, benefits, and alternatives to surgery with patients is a defining component of informed consent. As shared-decision making has become central to surgeon-patient communication, risk calculators have emerged as a tool to aid communication and decision-making. To optimize informed consent, it is necessary to understand how surgeons assess and communicate risk, and the role of risk calculators in this process.

Methods: We conducted interviews with 13 surgeons from two institutions to understand how surgeons assess risk, the role of risk calculators in decision-making, and how surgeons approach risk communication during informed consent. We performed a qualitative analysis of interviews based on SRQR guidelines.

Results: Our analysis yielded insights regarding (a) the landscape and approach to obtaining surgical consent; (b) detailed perceptions regarding the value and design of assessing and communicating risk; and (c) practical considerations regarding the future of personalized risk communication in decision-making. Above all, we found that non-clinical factors such as health and risk literacy are changing how surgeons assess and communicate risk, which diverges from traditional risk calculators.

Conclusion: Principally, we found that surgeons incorporate a range of clinical and non-clinical factors to risk stratify patients and determine how to optimally frame and discuss risk with individual patients. We observed that surgeons' perception of risk communication, and the importance of eliciting patient preferences to direct shared-decision making, did not consistently align with patient priorities. This study underscored criticisms of risk calculators and novel decision-aids - which must be addressed prior to greater adoption.

Keywords: Informed consent; Risk calculator; Risk communication; Shared-decision making.

MeSH terms

Decision Making
Decision Making, Shared*
Humans
Informed Consent
Surgeons*

Abstract

MeSH terms

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