title: Shared Decision Making and Choice for Elective Surgical Care: A Systematic Review.
abstract: OBJECTIVE
  Shared decision making (SDM), an integrative patient-provider communication process emphasizing discussion of scientific evidence and patient/family values, may improve quality care delivery, promote evidence-based practice, and reduce overuse of surgical care. Little is known, however, regarding SDM in elective surgical practice. The purpose of this systematic review is to synthesize findings of studies evaluating use and outcomes of SDM in elective surgery.
  
  
  METHODS
  PubMed, Cochrane CENTRAL, EMBASE, CINAHL, and SCOPUS electronic databases.
  
  
  METHODS
  We searched for English-language studies (January 1, 1990, to August 9, 2015) evaluating use of SDM in elective surgical care where choice for surgery could be ascertained. Identified studies were independently screened by 2 reviewers in stages of title/abstract and full-text review. We abstracted data related to population, study design, clinical dilemma, use of SDM, outcomes, treatment choice, and bias.
  
  
  RESULTS
  Of 10,929 identified articles, 24 met inclusion criteria. The most common area studied was spine (7 of 24), followed by joint (5 of 24) and gynecologic surgery (4 of 24). Twenty studies used decision aids or support tools, including modalities that were multimedia/video (13 of 20), written (3 of 20), or personal coaching (4 of 20). Effect of SDM on preference for surgery was mixed across studies, showing a decrease in surgery (9 of 24), no difference (8 of 24), or an increase (1 of 24). SDM tended to improve decision quality (3 of 3) as well as knowledge or preparation (4 of 6) while decreasing decision conflict (4 of 6).
  
  
  CONCLUSIONS
  SDM reduces decision conflict and improves decision quality for patients making choices about elective surgery. While net findings show that SDM may influence patients to choose surgery less often, the impact of SDM on surgical utilization cannot be clearly ascertained.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Erudnic2@jhmi.edu.
authors.forename: Emily F
authors.initials: EF
authors.lastname: Boss
authors.affiliation: evidENT, Ear Institute, University College London, London, UK.
authors.forename: Nishchay
authors.initials: N
authors.lastname: Mehta
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Neeraja
authors.initials: N
authors.lastname: Nagarajan
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Anne
authors.initials: A
authors.lastname: Links
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: James R
authors.initials: JR
authors.lastname: Benke
authors.affiliation: Division of General Internal Medicine, Johns Hopkins School of Medicine; Department of Health, Behavior, and Society, Johns Hopkins University School of Public Health; Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland, USA.
authors.forename: Zackary
authors.initials: Z
authors.lastname: Berger
authors.affiliation: Department of Otolaryngology, Children's National Health System, Washington, DC, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Espinel
authors.affiliation: Department of Otolaryngology, Children's National Health System, Washington, DC, USA.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Meier
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA.
authors.forename: Ellen A
authors.initials: EA
authors.lastname: Lipstein
mesh_terms: D002755:Choice Behavior; D003657:Decision Making; D003661:Decision Support Techniques; D017558:Elective Surgical Procedures; D006801:Humans
keywords: decision aid; decision support tool; elective surgery; informed decision making; shared decision-making; systematic review