Shared Decision-Making in Pancreatic Surgery

OBJECTIVE: The objective of this study is to determine the factors influencing pancreatic surgery patients’ perceptions of the shared decision-making process (SDM). BACKGROUND: Decision-making in pancreatic surgery is complicated by the risk of morbidity and mortality and risk of early recurrence of disease. Improvement in SDM has the potential to improve the receipt of goal- and value-concordant care. METHODS: This cross-sectional survey included patients who underwent pancreatic surgery. The following components were studied in relation to SDM: modified satisfaction with decision scale (SWD), modified decisional regret scale (DRS), quality of physician and patient interaction, and the impact of quality of life (FACT-Hep). Correlations were computed using Pearson’s correlation score and a regression model. RESULTS: The survey completion rate was 72.2% (of 40/55) and the majority (72.5%) of patients underwent pancreaticoduodenectomy. There were significant positive relationships between the SDM measure and (DRS, SWD; r = 0.70, P < 0.001) and responses to questions regarding how well the patient’s actual recovery matched their expectations before treatment (r = 0.62, P < 0.001). The quality of the physician–patient relationship correlated with how well recovery matched expectations (r = 0.53, P = 0.002). SDM measure scores were significant predictors of the decision evaluation measure (R(2)(adj) = 0.48, P < 0.001), FACT-Hep (R(2)(adj) = 0.15, P < 0.001), and recovery expectations measure (R(2)(adj) = 0.37, P < 0.001). CONCLUSIONS: Improved SDM in pancreatic surgery is associated with more realistic recovery expectations, decreased decisional regret, and improved quality of life.