Surgeon-Patient Communication in Surgical Decision-Making

Introduction to Shared Decision-Making

The American College of Critical Care Medicine and American Thoracic Society establish that surgeons should explicitly discuss decision-making preferences with families, recognizing that different families approach decisions differently 1, 2, 3
Surgeons must directly ask families how they prefer to make decisions—whether they want to share responsibility, make decisions independently after receiving information, or prefer the surgeon to make recommendations based on the patient's values 2, 4

Most families prefer to work collaboratively with the surgeon, combining medical knowledge with patient values, which is known as shared responsibility 1, 2
Some families want complete information but prefer to decide independently, known as family-led decisions 2, 3
Other families prefer to communicate the patient's values and have the surgeon make recommendations, with opportunity to disagree, known as surgeon-led recommendations 2, 4

The surgeon must present each option's advantages and disadvantages in a balanced manner, explicitly stating that "different people make different choices" to avoid steering families toward a particular decision 1, 3, 4
Surgeons must explicitly ask families what makes the patient's life worth living and whether the patient would accept specific functional limitations to remain alive 1, 3, 4
After understanding patient values, surgeons should synthesize this information into a clear recommendation that explicitly connects the patient's stated values to the proposed treatment 4

Surgeons must explicitly present the risks of both performing and not performing surgery, particularly when not operating carries risk of irreversible consequences 5, 6

Informed consent requires providing sufficient information for patients to make sound judgments about whether to proceed, including the purpose of treatment, expected benefits, significant risks, and alternatives 8, 6
Competent adult patients have the right to refuse treatment even if life-saving, and the surgeon's preference or desire to gain experience should never influence treatment choice 8
Information given to patients and families about medical conditions and treatment options should be recorded in clinical records, including the agreement to treatment with patient signature and the name of the clinician obtaining consent 8