K. M. Mueck1, M. I. Leal1, C. C. Wan1, B. F. Goldberg1, T. E. Saunders1, S. G. Millas1, M. K. Liang1, T. C. Ko1, L. S. Kao1 1University Of Texas Health Science Center At Houston,General Surgery,Houston, TX, USA
Introduction: Shared decision-making (SDM) promotes informed, patient-centered healthcare. However, little is known about vulnerable patients’ perceptions regarding SDM during surgical evaluation and the accuracy of existing tools for measuring SDM. The purpose of this study was to evaluate whether a commonly used tool, the Shared Decision Making Questionnaire (SDMQ9), accurately reflects perceptions of SDM among medically underserved patients seeking surgical evaluation for gallstones at a safety-net hospital.
Methods: An exploratory qualitative study was conducted in a sample of adult patients with gallstones at a safety-net surgery clinic between May-July 2016. Semi-structured interviews were conducted after initial surgical consultation. Patients were administered the SDMQ9 which has been validated in English and Spanish and Autonomy Preference Scale (APS). Interviews were analyzed using thematic content analysis and investigator triangulation was used to establish credibility. Interviews and questionnaires were determined to reflect SDM if responses were equivalent to “strongly agree” or “completely agree”. Univariate analyses were performed to identify factors associated with SDM and to compare results of the surveys to those of the interviews.
Results: The majority of patients (N=20) were female (85%), Hispanic (80%), Spanish speaking (70%), and middle-aged (46.8 ± 15 years). Most had a diagnosis of symptomatic cholelithiasis (55%), though 4 patients (20%) had non-biliary diagnoses. Non-operative management was chosen for 8 (40%) patients following surgical consultation. The proportion of patients who perceived SDM was significantly higher based on the SDMQ9 versus interviews (85% vs 35%, p<0.01). Age, sex, race/ethnicity, language, diagnosis, desire for autonomy based on the APS, and decision to pursue surgery were not associated with SDM. Analysis of component questions similarly demonstrated significantly higher perceived SDM based on the SDMQ9 in patient involvement in decision-making (90% vs 35%, p<0.01), discussion of treatment options (85% vs 50%, p=0.02), physician explanation of all information (90% vs 45%, p=0.04), and joint weighing of treatment options (75% vs 20%, p<0.01). Interview themes suggest that contributory factors to this discordance include patient unfamiliarity with the concept of SDM, deference to the surgeons’ authority, lack of discussion about treatment options, and confusion between aligned versus shared decisions.
Conclusion: Understanding patient perspectives regarding SDM is crucial to providing informed, patient-centered care. Discordance between two methods for assessing vulnerable patients’ perceptions of SDM during surgical evaluation suggests that modifications to current measurement strategies may need to occur when assessing SDM in vulnerable patients. Furthermore, such metrics should be assessed for correlation with patient-centered outcomes.