High-quality shared decision-making processes are essential to patient-centred care and are an important part of modern healthcare systems.
Shared decision making is when patients and health professionals make treatment decisions together. It is particularly important for patients undergoing surgical procedures because, unlike many medical therapies, the effects of surgery are usually immediate and irreversible.
As part of a larger study, researchers have developed an automated electronic system that gathers information from patients about their experiences of shared decision making in relation to their surgery, analyses the information, and feeds it back to the clinical team.
The electronic system is in place in surgery departments at hospitals in Bristol and Bradford.
A new study has investigated whether the system is acceptable to patients and surgeons, through interviews with 18 adult surgical patients and 14 surgeons, who had all used the system.
Patients and surgeons said they felt it has the potential to help surgeons better involve patients in decisions about their surgery. They felt it helped surgeons address problems patients identified, efficiently and on a large scale.
This benefits patients, surgeons and the whole organisation.
On the other hand, study participants pointed out that patients’ views on how well they were involved in decision making might be influenced by factors unrelated to conversations with their surgeon. For example, patients’ views might vary depending on the type of surgery they had, exactly when they were asked for their views, and their overall experience of being in hospital.
Patients were also concerned that using an electronic system to collect information might exclude some groups of patients. For example, elderly, ethnic minority and disabled patients may have difficulty accessing and using it. The research team is undertaking research to better understand these barriers and find ways to address them.
Surgeons said they needed detailed information about patients’ reasons for being dissatisfied with decision-making processes, not simply a satisfaction score.
The findings from this study will be used to refine the electronic system before it is further tested as part of a large trial.
The ultimate aim of this work is to develop and test a programme to improve shared decision making in the NHS.
Dr Christin Hoffmann, study lead and Research Fellow at NIHR Bristol BRC, said: “The electronic system offers an efficient and scalable way to routinely listen to patients’ experiences. It marks a step change in how we monitor and support shared decision making in surgery.
“This study has given us valuable insights into how we can refine the system to better meet the needs of both patients and surgeons.
“Our goal is to ensure that every surgical patient, regardless of their background, is involved in choosing their treatment, and feels supported to make a choice that is right for them.”
Dr Christie Cabral, Senior Lecturer at the Centre for Academic Primary Care (CAPC), said: “As Lord Darzi highlighted in his report on the NHS, quality care means care that is patient-centred. This system helps us make that a reality by capturing patients’ voices on how involved they feel in decisions about their surgery, and using that feedback to improve care.
“Our follow-on study will also look at links with primary care, because of the important role played by GPs in supporting patients before and after surgery.”