title: Responding to trust: surgeons' perspective on informed consent.
abstract: BACKGROUND
  Every day thousands of surgeons and patients negotiate their way through the complex process of decision-making about operative treatments. We conducted a series of qualitative studies, asking patients and surgeons to describe their experience and beliefs about informed decision-making and consent. This study focuses on surgeons' views.
  
  
  METHODS
  Open-ended interviews and focus group discussions were conducted with thoracic surgeons who treated esophageal cancer patients by esophagectomy, and general surgeons who routinely performed laparoscopic cholecystectomy. Their views were analyzed using a qualitative approach, grounded in the perspectives of the participants.
  
  
  RESULTS
  Five dominant themes emerged from the analysis: (1) making informed decisions; (2) communicating information and confidence; (3) managing expectations and fears; (4) consent as a decision to trust; (5) commitment inspired by trust. These themes are illustrated by verbatim quotes from the surgeon interviews.
  
  
  CONCLUSIONS
  Surgeons carefully assess the risks and benefits of treatment before consenting to perform operative interventions. They are influenced by objective findings and by affective factors such as courage and the determination to survive expressed by their patients. They manage risks, doubts, and fears-both their patients' and their own-relying on trust and commitment on both sides to ensure the success of the surgical mission. The trust of their patients has a strong influence on the surgeons' decisions and actions.
authors.affiliation: Toronto General Hospital, University of Toronto, Department of Surgery and Joint Centre for Bioethics, Toronto, ON, Canada. martin.mckneally@utoronto.ca
authors.forename: Martin F
authors.initials: MF
authors.lastname: McKneally
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Martin
authors.forename: Esther
authors.initials: E
authors.lastname: Ignagni
authors.forename: Jason
authors.initials: J
authors.lastname: D'Cruz
mesh_terms: D001291:Attitude of Health Personnel; D002763:Cholecystectomy / Q000592:standards / Q000639:trends; D003657:Decision Making; D005260:Female; D006801:Humans; D007258:Informed Consent / Q000523:psychology*; D007407:Interviews as Topic; D008297:Male; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D010817:Physician-Patient Relations; D011787:Quality of Health Care; D011795:Surveys and Questionnaires; D019616:Thoracic Surgical Procedures / Q000592:standards / Q000639:trends; D035502:Trust / Q000523:psychology*