Evidence map›Paper›PMID 37468387›Full record

ArticleAmerican journal of surgery2023

How surgeons use risk calculators and non-clinical factors for informed consent and shared decision making: A qualitative study.

Jasmine Panton, Brendin R Beaulieu-Jones, Jayson S Marwaha, Alison P Woods, Drashko Nakikj, Nils Gehlenborg, Gabriel A Brat

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in American journal of surgery, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.

0numbers the graph read from it
0cells of the map it votes in
10citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

10 citing papers in PubMed.

  1. Article
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  3. Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Jasmine PantonGeisel School of Medicine at Dartmouth, Hanover, NH, USA; Department of Surgery, Beth Israel Deaconess Medical Center (BIDMC), Boston, MA, USA.
Brendin R Beaulieu-JonesDepartment of Surgery, Beth Israel Deaconess Medical Center (BIDMC), Boston, MA, USA; Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA.
Jayson S MarwahaDepartment of Surgery, Beth Israel Deaconess Medical Center (BIDMC), Boston, MA, USA; Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA.
Alison P WoodsDepartment of Surgery, Beth Israel Deaconess Medical Center (BIDMC), Boston, MA, USA; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Drashko NakikjDepartment of Biomedical Informatics, Harvard Medical School, Boston, MA, USA.
Nils GehlenborgDepartment of Biomedical Informatics, Harvard Medical School, Boston, MA, USA.
Gabriel A BratDepartment of Surgery, Beth Israel Deaconess Medical Center (BIDMC), Boston, MA, USA; Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA. Electronic address: gbrat@bidmc.harvard.edu.

Funding

RESEARCH TRAINING-MEDICAL INFORMATICS 90T15LM007092 · NLM · HARVARD UNIVERSITY (SCH OF PUBLIC HLTH) · PI Nils Gehlenborg · 1992 to 2026
$32.8M
HARVARD-LONGWOOD RESEARCH TRAINING IN VASCULAR SURGERYT32HL007734 · NHLBI · BETH ISRAEL DEACONESS MEDICAL CENTER · PI FERRAN, CHRISTIANE, LOGERFO, FRANK W · 1993 to 2023
$10.5M
Clinical and Laboratory Research Training for Surgical OncologistsT32CA126607 · NCI · JOHNS HOPKINS UNIVERSITY · PI CAMERON, ANDREW M. · 2008 to 2024
$6.0M
Harvard-Longwood Short-Term Research Training in Vascular SurgeryT35HL110843 · NHLBI · BETH ISRAEL DEACONESS MEDICAL CENTER · PI CHRISTIANE FERRAN, FRANK W LOGERFO · 2013 to 2026
$609k
NCI NIH HHS T32 CA126607NHLBI NIH HHS T32 HL007734NHLBI NIH HHS T35 HL110843NLM NIH HHS T15 LM007092
6 · The paper itself

Abstract

backgroundThe discussion of risks, benefits, and alternatives to surgery with patients is a defining component of informed consent. As shared-decision making has become central to surgeon-patient communication, risk calculators have emerged as a tool to aid communication and decision-making. To optimize informed consent, it is necessary to understand how surgeons assess and communicate risk, and the role of risk calculators in this process.

methodsWe conducted interviews with 13 surgeons from two institutions to understand how surgeons assess risk, the role of risk calculators in decision-making, and how surgeons approach risk communication during informed consent. We performed a qualitative analysis of interviews based on SRQR guidelines.

resultsOur analysis yielded insights regarding (a) the landscape and approach to obtaining surgical consent; (b) detailed perceptions regarding the value and design of assessing and communicating risk; and (c) practical considerations regarding the future of personalized risk communication in decision-making. Above all, we found that non-clinical factors such as health and risk literacy are changing how surgeons assess and communicate risk, which diverges from traditional risk calculators.

conclusionPrincipally, we found that surgeons incorporate a range of clinical and non-clinical factors to risk stratify patients and determine how to optimally frame and discuss risk with individual patients. We observed that surgeons' perception of risk communication, and the importance of eliciting patient preferences to direct shared-decision making, did not consistently align with patient priorities. This study underscored criticisms of risk calculators and novel decision-aids - which must be addressed prior to greater adoption.

Indexed as

Decision Making, SharedSurgeonsDecision MakingHumansInformed ConsentInformed consentRisk calculatorRisk communicationShared-decision making

Identifiers

PMID37468387
PMCPMC10592325

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.