title: Informed decision-making in elective major vascular surgery: analysis of 145 surgeon-patient consultations.
abstract: BACKGROUND
  Prior studies show significant gaps in the informed decision-making process, a central goal of surgical care. These studies have been limited by their focus on low-risk decisions, single visits rather than entire consultations, or both. Our objectives were, first, to rate informed decision-making for major elective vascular surgery based on audiotapes of actual physician-patient conversations and, second, to compare ratings of informed decision-making for first visits to ratings for multiple visits by the same patient over time.
  
  
  METHODS
  We prospectively enrolled patients for whom vascular surgical treatment was a potential option at a tertiary care outpatient vascular surgery clinic. We audio-taped all surgeon-patient conversations, including multiple visits when necessary, until a decision was made. Using an existing method, we evaluated the transcripts for elements of decision-making, including basic elements (e.g., an explanation of the clinical condition), intermediate elements (e.g., risks and benefits) and complex elements (e.g., uncertainty around the decision).
  
  
  RESULTS
  We analyzed 145 surgeon-patient consultations. Overall, 45% of consultations contained complex elements, whereas 23% did not contain the basic elements of decision-making. For the 67 consultations that involved multiple visits, ratings were significantly higher when evaluating all visits (50% complex elements) compared with evaluating only the first visit (33% complex elements, p < 0.001.)
  
  
  CONCLUSIONS
  We found that 45% of consultations contained complex elements, which is higher than prior studies with similar methods. Analyzing decision-making over multiple visits yielded different results than analyzing decision-making for single visits.
authors: Department of Medicine, University of Toronto, Ont., Canada. edward.etchells@sunnybrook.ca
authors: Edward
authors: E
authors: Etchells
authors: Michel
authors: M
authors: Ferrari
authors: Alex
authors: A
authors: Kiss
authors: Nikki
authors: N
authors: Martyn
authors: Deborah
authors: D
authors: Zinman
authors: Wendy
authors: W
authors: Levinson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001014:Aortic Aneurysm / Q000601:surgery; D016893:Carotid Stenosis / Q000601:surgery; D003142:Communication; D015986:Confounding Factors, Epidemiologic; D003657:Decision Making; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007258:Informed Consent; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D009864:Ontario; D010358:Patient Participation; D058729:Peripheral Arterial Disease / Q000601:surgery; D010817:Physician-Patient Relations; D011446:Prospective Studies; D012307:Risk Factors; D013637:Tape Recording; D035501:Uncertainty; D014648:Varicose Veins / Q000601:surgery; D014656:Vascular Surgical Procedures