Informed Consent and Shared Decision Making in the Perioperative Environment

Abstract

Informed consent and shared decision making (SDM) are crucial portions of preoperative patient management. Informed consent is a standard for surgery from both a legal and ethical standpoint, involving disclosure of potential risks of a procedure and ensuring patient understanding of these risks. SDM is a process in which a clinician and patients decide between two or more treatment plans, taking into account the patient's goals and values. SDM is a particularly important aspect of patient-centered care when two or more treatment options exist or in situations where an indicated treatment may not align with the patient's long-term goals. This article details aspects of and issues surrounding informed consent and SDM.

Keywords

informed consent - shared decision making - patient-centered care - palliative care

Publication History

Article published online:
28 January 2023

• References

• 1 Jefford M, Moore R. Improvement of informed consent and the quality of consent documents. Lancet Oncol 2008; 9 (05) 485-493
• 2 Bernat JL, Peterson LM. Patient-centered informed consent in surgical practice. Arch Surg 2006; 141 (01) 86-92
• 3 Murray B. Informed consent: what must a physician disclose to a patient?. Virtual Mentor 2012; 14 (07) 563-566
• 4 Canterbury v Spence. 464 F.2d. 772, 782 D.C. Cir. 1972
• 5 Childers R, Lipsett PA, Pawlik TM. Informed consent and the surgeon. J Am Coll Surg 2009; 208 (04) 627-634
• 6 Scheer AS, O'Connor AM, Chan BP. et al. The myth of informed consent in rectal cancer surgery: what do patients retain?. Dis Colon Rectum 2012; 55 (09) 970-975
• 7 Oshima Lee E, Emanuel EJ. Shared decision making to improve care and reduce costs. N Engl J Med 2013; 368 (01) 6-8
• 8 Frosch DL, Kaplan RM. Shared decision making in clinical medicine: past research and future directions. Am J Prev Med 1999; 17 (04) 285-294
• 9 Niburski K, Guadagno E, Abbasgholizadeh-Rahimi S, Poenaru D. Shared decision making in surgery: a meta-analysis of existing literature. Patient 2020; 13 (06) 667-681
• 10 Légaré F, Witteman HO. Shared decision making: examining key elements and barriers to adoption into routine clinical practice. Health Aff (Millwood) 2013; 32 (02) 276-284
• 11 Kon AA. The shared decision-making continuum. JAMA 2010; 304 (08) 903-904
• 12 Baggett ND, Schulz K, Buffington A. et al. Surgeon use of shared decision-making for older adults considering major surgery: a secondary analysis of a randomized clinical trial. JAMA Surg 2022; 157 (05) 406-413
• 13 Degner LF, Sloan JA. Decision making during serious illness: what role do patients really want to play?. J Clin Epidemiol 1992; 45 (09) 941-950
• 14 Austin CA, Mohottige D, Sudore RL, Smith AK, Hanson LC. Tools to promote shared decision making in serious illness: a systematic review. JAMA Intern Med 2015; 175 (07) 1213-1221
• 15 Stacey D, Légaré F, Lewis K. et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2017; 4 (04) CD001431
• 16 Wu RC, Boushey RP, Scheer AS. et al. Evaluation of the rectal cancer patient decision aid: a before and after study. Dis Colon Rectum 2016; 59 (03) 165-172
• 17 Wu R, Boushey R, Potter B, Stacey D. The evaluation of a rectal cancer decision aid and the factors influencing its implementation in clinical practice. BMC Surg 2014; 14: 16
• 18 Taylor LJ, Nabozny MJ, Steffens NM. et al. A framework to improve surgeon communication in high-stakes surgical decisions: best case/worst case. JAMA Surg 2017; 152 (06) 531-538
• 19 Wong ML, Nicosia FM, Smith AK. et al. “You have to be sure that the patient has the full picture”: adaptation of the best case/worst case communication tool for geriatric oncology. J Geriatr Oncol 2022; 13 (05) 606-613
• 20 Kruser JM, Taylor LJ, Campbell TC. et al. “Best case/worst case”: training surgeons to use a novel communication tool for high-risk acute surgical problems. J Pain Symptom Manage 2017; 53 (04) 711-719.e5
• 21 Kruser JM, Nabozny MJ, Steffens NM. et al. “Best case/worst case”: qualitative evaluation of a novel communication tool for difficult in-the-moment surgical decisions. J Am Geriatr Soc 2015; 63 (09) 1805-1811
• 22 Mosenthal AC, Murphy PA. Interdisciplinary model for palliative care in the trauma and surgical intensive care unit: Robert Wood Johnson Foundation Demonstration Project for Improving Palliative Care in the Intensive Care Unit. Crit Care Med 2006; 34 (11, Suppl): S399-S403
• 23 Mosenthal AC, Dunn GP. Surgical Palliative Care. New York, NY: Oxford University Press; 2019
• 24 Lilley EJ, Khan KT, Johnston FM. et al. Palliative care interventions for surgical patients: a systematic review. JAMA Surg 2016; 151 (02) 172-183
• 25 Yefimova M, Aslakson RA, Yang L. et al. Palliative care and end-of-life outcomes following high-risk surgery. JAMA Surg 2020; 155 (02) 138-146
• 26 Suwanabol PA, Kanters AE, Reichstein AC. et al. Characterizing the role of U.S. surgeons in the provision of palliative care: a systematic review and mixed-methods meta-synthesis. J Pain Symptom Manage 2018; 55 (04) 1196-1215.e5
• 27 Heller DR, Jean RA, Chiu AS. et al. Regional differences in palliative care utilization among geriatric colorectal cancer patients needing emergent surgery. J Gastrointest Surg 2019; 23 (01) 153-162
• 28 Shinall Jr MC, Hoskins A, Hawkins AT. et al. A randomized trial of a specialist palliative care intervention for patients undergoing surgery for cancer: rationale and design of the Surgery for Cancer with Option of Palliative Care Expert (SCOPE) trial. Trials 2019; 20 (01) 713
• 29 Aslakson RA, Chandrashekaran SV, Rickerson E. et al. A multicenter, randomized controlled trial of perioperative palliative care surrounding cancer surgery for patients and their family members (PERIOP-PC). J Palliat Med 2019; 22 (S1): 44-57
• 30 Dibley L, Czuber-Dochan W, Wade T. et al; members of the stoma PPI team. Patient decision-making about emergency and planned stoma surgery for IBD: a qualitative exploration of patient and clinician perspectives. Inflamm Bowel Dis 2018; 24 (02) 235-246
• 31 Pieracci FM, Ullery BW, Eachempati SR. et al. Prospective analysis of life-sustaining therapy discussions in the surgical intensive care unit: a housestaff perspective. J Am Coll Surg 2008; 207 (04) 468-476
• 32 Hawley ST, Morris AM. Cultural challenges to engaging patients in shared decision making. Patient Educ Couns 2017; 100 (01) 18-24