Identifying Patient Characteristics Associated With Deficits in Surgical Decision Making.

BACKGROUND: Patient involvement in surgical decisions is formalized in the informed consent process, which should reflect that the patient understands their diagnosis, planned procedure, and the associated risks and benefits before consenting to treatment. If high-quality shared decision making has occurred, the treatment chosen should best match the goals and preferences of the patient. Little information currently exists that analyzes factors associated with decisional quality in surgery. Identifying patient factors correlated with specific deficits in preoperative decision making is essential for improvement of the shared decision-making process. This study aims to identify patient characteristics and coping strategies associated with the presence of knowledge deficits regarding their diagnosis and procedure so that interventions can be targeted to these vulnerable groups.

METHODS: Approximately 882 preoperative patients were assessed regarding understanding of their diagnosis and procedure. Sociodemographic and decision-making variables were evaluated using validated measures. Univariate analysis and logistic regression models assessed factors associated with lower decisional quality.

RESULTS: Approximately 136 (15%) of 882 patients had deficits in knowledge of diagnosis and/or procedure. Older patients were more likely to demonstrate these deficits (P = 0.0002). Using multivariate analysis, independent predictors of knowledge deficits included patients who identified themselves as Black, Asian, or other race (odds ratio [OR], 2.63; 95% confidence interval [CI], 1.19-5.85; and OR, 1.88; 95% CI, 1.00-3.55, respectively); were older (OR, 1.02; 95% CI, 1.01-1.04); and used denial as a coping strategy (OR, 2.61; 95% CI, 1.29-5.28). The use of acceptance as a coping strategy negatively predicted knowledge deficits (OR, 0.55; 95% CI, 0.36-0.84).

CONCLUSIONS: Specific patient factors and coping strategies are associated with deficiencies in decisional quality. Identifying vulnerable groups at risk for these issues can help target methodologies and resources to ensure high-quality surgical decision making.