PeriOperative Quality Initiative consensus statement recommendations on the definitions, aims and delivery of shared decision-making for major surgery

Abstract

Introduction: Shared decision-making is a collaborative process whereby clinicians and patients work together to decide on a treatment plan that is informed by evidence, clinical experience and individual patient characteristics and preferences. This process is particularly important for complex surgical decisions when the risks and benefits of treatment are finely balanced. However, shared decision-making has not been implemented consistently in peri-operative pathways and structured shared decision-making for patients requiring enhanced decisional support is not widely available. We aimed to develop clinical practice recommendations for peri-operative shared decision-making through an international consensus process. Methods: A modified nominal group technique was utilised, comprising seven stages. Idea generation (stages 1 and 2) was conducted online. Stages 3–7 occurred in person over 2.5 days and involved iterative rounds of deliberation, refinement and voting to develop consensus statements and recommendations. An international multidisciplinary group of 22 experts was purposively selected to represent diverse perspectives across healthcare settings and reflected relevant stakeholders in peri-operative shared decision-making. Three consumer advisors were also recruited who had lived experience of major surgery either as a patient or carer. Results: Consensus for recommendations was defined a priori as 75% of all faculty indicating agreement across successive rounds of anonymous voting. Universal consensus was obtained on 25 recommendations, which included a definition of ‘universal shared decision-making’ for all patients contemplating surgery and referral criteria for ‘specialised shared decision-making services’ for patients with higher decisional-support needs. The core components of shared decision-making services and priority areas for research were also identified. Discussion: This is the first consensus statement recommendations for peri-operative shared decision-making co-created by consumers and clinicians. It will support the implementation of shared decision-making for patients contemplating surgery.