Time for a paradigm shift in shared decision-making in trauma and emergency surgery? Results from an international survey
Lorenzo Cobianchi, Francesca Dal Mas, Vanni Agnoletti, Luca Ansaloni, Walter Biffl, Giovanni Butturini, Stefano Campostrini, Fausto Catena, Stefano Denicolai, Paola Fugazzola, Jacopo Martellucci, Maurizio Massaro, Pietro Previtali, Federico Ruta, Alessandro Venturi, Sarah Woltz, Haytham M.A. Kaafarani, Tyler J. Loftus, the Team Dynamics Study Group, Recayi Aapoäÿlu, Kenneth L. Abbott, Abubaker Abdelmalik, Nebyou Seyoum Abebe, Fikri M. Abu‐Zidan, Yousif Abdallah Yousif Adam, Harissou Adamou, Dmitry Mikhailovich Adamovich, Ferdinando Agresta, Antonino Agrusa, Emrah Akın, M Alessiani, Henrique Alexandrino, Chiara Bidoli, Syed Muhammad Ali, Vasilescu Alin Mihai, Pedro Miguel Almeida, Mohammed Mohammed Al-Shehari, Michele Altomare, Francesco Amico, Michele Ammendola, Jacopo Andreuccetti, Εlissavet Anestiadou, Alfredo Annicchiarico, Amedeo Antonelli, Daniel Aparicio-Sanchez, Antonella Ardito, Giulio Argenio, Catherine Claude Arvieux, C. Arvieux, Ingolf Askevold, Boyko Atanasov, Goran Augustin, Selmy Awad, Giulia Bacchiocchi, Carlo Bagnoli, Hany Bahouth, Efstratia Baili, Lovenish Bains, Gian Luca Baiocchi, Miklosh Bala, Carmen Balaguà©, Dimitrios Balalis, E Baldini, oussama Baraket, Suman Baral, Mirko Barone, Alberto Gonzãlez Barranquero, Jorge Arturo Barreras, Gary Alan Bass, Zülfü Bayhan, Giovanni Bellanova, Offir Ben‐Ishay, Fabrizio Bert, Valentina Bianchi, Helena Biancuzzi, Raluca Bievel Radulescu, Mark Brian Bignell, Alan Biloslavo, Roberto Bini, Daniele Bissacco, Paoll Boati, Guillaume Boddaert, Branko Bogdanić, Cristina Bombardini, Luigi Bonavina, L Bonomo, Andrea Bottari, Konstantinos Bouliaris, Gioia Brachini, Antonio Brillantino, Giuseppe Brisinda, Maloni Mamada Bulanauca, Luis Antonio Buonomo, Jakob Burcharth, Salvatore Buscemi, Francesca Calabretto, Giacomo Calini, Valentin Calu, Fabio Cesare Campanile, Riccardo Campo Dall′Orto
Abstract
BACKGROUND: Shared decision-making (SDM) between clinicians and patients is one of the pillars of the modern patient-centric philosophy of care. This study aims to explore SDM in the discipline of trauma and emergency surgery, investigating its interpretation as well as the barriers and facilitators for its implementation among surgeons. METHODS: Grounding on the literature on the topics of the understanding, barriers, and facilitators of SDM in trauma and emergency surgery, a survey was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was sent to all 917 WSES members, advertised through the society's website, and shared on the society's Twitter profile. RESULTS: A total of 650 trauma and emergency surgeons from 71 countries in five continents participated in the initiative. Less than half of the surgeons understood SDM, and 30% still saw the value in exclusively engaging multidisciplinary provider teams without involving the patient. Several barriers to effectively partnering with the patient in the decision-making process were identified, such as the lack of time and the need to concentrate on making medical teams work smoothly. DISCUSSION: Our investigation underlines how only a minority of trauma and emergency surgeons understand SDM, and perhaps, the value of SDM is not fully accepted in trauma and emergency situations. The inclusion of SDM practices in clinical guidelines may represent the most feasible and advocated solutions.