Documentation of shared decision making in the preoperative surgical note
D. Pelipeychenko 1,4, MD; D. MacDonald 1,4, MD, FRCPC; L. Boland
4
MSc, PhD(c); D.I. McIsaac1,2,3,4, MD, MPH, FRCPC
Department of Anesthesiology1, Faculty of Medicine2, The Ottawa Hospital Research Institute3, The University of Ottawa4.
Introduction
• Shared decision making (SDM) is an evidence based
collaborative decision making approach between the
healthcare professional and patients (2)
• Given the increased risk associated with surgery in the elderly,
SDM helps to ensure patients make surgical decisions
consistent with their preferences and values
• Best practice guidelines recommend documentation of SDM in
the surgical consultation note (3)
• Patients making difficult decisions often experience decisional
conflict, which can lead to poorer outcomes if decisional needs
are not addressed (4)
Objective
• Consultation notes were available for 233/240 patients (97%)
SDM:
• 100% of consultation notes documented an actual choice being made
and the plan for implementation of that choice (Figure 1)
• The patient’s treatment preferences (15%) and self-efficacy (3%)
were least commonly documented
• No consultation note documented all 9 SDM elements (Figure 2)
Patients’ decisional needs (SURE test):
• Patients’ certainty about the decision, categorized as “Sure of
myself”, was documented most often (16%) (Figure 3A)
• Having adequate support and advice, categorized as
“Encouragement”, was least frequently documented (2%) (Figure 3A)
• No consultation note documented all 4 SURE test items (Figure 3B)
• To evaluate surgeons’ documentation of SDM and patient
decisional needs in the preoperative surgical consultation note
among elderly patients having elective surgery
Design:
• Mixed methods cross-sectional study; REB approved
Population and setting:
Figure 2: Cumulative number of SDM criteria documented in a consultation
note.
Table 1: SURE criteria
SURE Acronym
Methods
Results cont.
Results
Items
Sure of myself
Do you feel SURE about the best choice for you?
Understand information
Do you know the benefits and risks of each option?
Risk-benefit ratio
Are you clear about which benefits and risks matter
most to you?
Encouragement
Do you have enough support and advice to make a
choice?
Figure 3: SURE criteria. A) Documentation of individual SURE criteria.
B) Cumulative number of SURE criteria documented in a consultation note.
• Tertiary care health sciences network
• Eligible patients were 65+ years and had elective surgery
• Chart review was performed on 240 randomly sampled
preoperative surgical consultation notes
Discussion
•
Given the increased risk associated with surgery in the
elderly, SDM and decisional needs assessment help to
ensure high-risk older patients make surgical decisions
consistent with their preferences (3,4)
• Our chart review demonstrates insufficient documentation of
SDM and patient decisional needs within the preoperative
surgical consultation notes of elderly patients
• This suggests a gap between guideline recommended and
actual SDM documentation
Outcomes and measures
• SDM and patients’ decisional needs were evaluated using 9
SDM elements (2, Figure 1) and the validated 4-item SURE
test, respectively (4, Table 1)
Data analysis:
• Two raters independently extracted data using pre-piloted forms
• Disagreements were resolved by consensus
• Descriptive analyses were calculated and triangulated
Figure 1: Documentation of individual SDM criteria.
References: 1. Soc Sci Med 1997 44(5):681-92. 2. Patient Educ Couns 2006 60(3):301-12. 3. Br J Anaesth 2015 115(2):15-25. 4. Can Fam Physician 2010 56(8):308-14.