PDF(Pubmed)
Abstract：
The discussion of risks, benefits, and alternatives to surgery with patients is a defining component of informed consent. As shared-decision making has become central to surgeon-patient communication, risk calculators have emerged as a tool to aid communication and decision-making. To optimize informed consent, it is necessary to understand how surgeons assess and communicate risk, and the role of risk calculators in this process.
We conducted interviews with 13 surgeons from two institutions to understand how surgeons assess risk, the role of risk calculators in decision-making, and how surgeons approach risk communication during informed consent. We performed a qualitative analysis of interviews based on SRQR guidelines.
Our analysis yielded insights regarding (a) the landscape and approach to obtaining surgical consent; (b) detailed perceptions regarding the value and design of assessing and communicating risk; and (c) practical considerations regarding the future of personalized risk communication in decision-making. Above all, we found that non-clinical factors such as health and risk literacy are changing how surgeons assess and communicate risk, which diverges from traditional risk calculators.
Principally, we found that surgeons incorporate a range of clinical and non-clinical factors to risk stratify patients and determine how to optimally frame and discuss risk with individual patients. We observed that surgeons\' perception of risk communication, and the importance of eliciting patient preferences to direct shared-decision making, did not consistently align with patient priorities. This study underscored criticisms of risk calculators and novel decision-aids - which must be addressed prior to greater adoption.
We conducted interviews with 13 surgeons from two institutions to understand how surgeons assess risk, the role of risk calculators in decision-making, and how surgeons approach risk communication during informed consent. We performed a qualitative analysis of interviews based on SRQR guidelines.
Our analysis yielded insights regarding (a) the landscape and approach to obtaining surgical consent; (b) detailed perceptions regarding the value and design of assessing and communicating risk; and (c) practical considerations regarding the future of personalized risk communication in decision-making. Above all, we found that non-clinical factors such as health and risk literacy are changing how surgeons assess and communicate risk, which diverges from traditional risk calculators.
Principally, we found that surgeons incorporate a range of clinical and non-clinical factors to risk stratify patients and determine how to optimally frame and discuss risk with individual patients. We observed that surgeons\' perception of risk communication, and the importance of eliciting patient preferences to direct shared-decision making, did not consistently align with patient priorities. This study underscored criticisms of risk calculators and novel decision-aids - which must be addressed prior to greater adoption.
摘要：
背景：关于风险的讨论，好处,对患者进行手术的替代方案是知情同意书的决定性组成部分。由于共同决策已成为外科医生与患者沟通的核心，风险计算器已经成为帮助沟通和决策的工具。优化知情同意，有必要了解外科医生如何评估和传达风险，以及风险计算器在这个过程中的作用。
方法：我们采访了来自两个机构的13名外科医生，以了解外科医生如何评估风险。风险计算器在决策中的作用，以及外科医生在知情同意期间如何进行风险沟通。我们根据SRQR指南对访谈进行了定性分析。
结果：我们的分析产生了以下方面的见解：（a）获得手术同意的景观和方法；（b）关于评估和沟通风险的价值和设计的详细看法；（c）关于决策中个性化风险沟通的未来的实际考虑。最重要的是,我们发现，非临床因素，如健康和风险素养正在改变外科医生评估和沟通风险的方式，这与传统的风险计算器不同。
结论：原则上，我们发现,外科医生将一系列临床和非临床因素纳入其中,以对患者进行风险分层,并确定如何对个体患者进行最佳评估和讨论风险.我们观察到外科医生对风险沟通的感知，以及激发患者偏好对指导共同决策的重要性，与患者的优先事项并不一致。这项研究强调了对风险计算器和新颖决策辅助工具的批评-在更多采用之前必须解决。
方法：我们采访了来自两个机构的13名外科医生，以了解外科医生如何评估风险。风险计算器在决策中的作用，以及外科医生在知情同意期间如何进行风险沟通。我们根据SRQR指南对访谈进行了定性分析。
结果：我们的分析产生了以下方面的见解：（a）获得手术同意的景观和方法；（b）关于评估和沟通风险的价值和设计的详细看法；（c）关于决策中个性化风险沟通的未来的实际考虑。最重要的是,我们发现，非临床因素，如健康和风险素养正在改变外科医生评估和沟通风险的方式，这与传统的风险计算器不同。
结论：原则上，我们发现,外科医生将一系列临床和非临床因素纳入其中,以对患者进行风险分层,并确定如何对个体患者进行最佳评估和讨论风险.我们观察到外科医生对风险沟通的感知，以及激发患者偏好对指导共同决策的重要性，与患者的优先事项并不一致。这项研究强调了对风险计算器和新颖决策辅助工具的批评-在更多采用之前必须解决。
