Shared decision-making in urology and female pelvic floor medicine and reconstructive surgery

• Published in: Nature reviews. Urology Vol. 19; no. 3; pp. 161 - 170
• Main Authors: Ossin, David A., Carter, Emily C., Cartwright, Rufus, Violette, Philippe D., Iyer, Shilpa, Klein, Geraldine T., Senapati, Sangeeta, Klaassen, Zachary, Botros, Sylvia M.
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.03.2022; Nature Publishing Group
• Subjects: 692/4025/2768; 692/700/1538; Clinical decision making; Decision Making; Decision Making, Shared; Female; Humans; Medicine; Medicine & Public Health; Patient Participation; Patients; Pelvic Floor; Plastic Surgery Procedures; Reconstructive surgery; Review Article; Urology
• ISSN: 1759-4812; 1759-4820; 1759-4820
• DOI: 10.1038/s41585-021-00551-4

Shared decision-making (SDM) is a hallmark of patient-centred care that uses informed consent to help guide patients with making complex health-care decisions. In SDM, patients and providers work together to determine the best course of action based on both the current available evidence and the patient’s values and preferences. SDM not only provides a framework for the legal and ethical obligations providers need to fulfil for informed consent, but also leads to improved knowledge of treatment options and satisfaction of decision-making for patients. Tools such as decision aids have been developed to support SDM for complex decisions. Several decision aids are available for use in the field of urology and female pelvic medicine and reconstructive surgery, but these decision aids are also associated with barriers to SDM implementation including patient, provider and systematic challenges. However, solutions to such barriers to SDM include continued development of SDM tools to improve patient engagement, expand training of providers in SDM communication models and a process to encourage implementation of SDM. In shared decision-making (SDM), patients and providers work together to determine the best course of action based on the current evidence and the patient’s own preferences. Tools such as decision aids can support SDM for complex decisions, but these decision aids are also associated with barriers to SDM implementation, including patient, provider and systematic challenges. In this Review, the authors discuss opportunities for and limitations of SDM in urology and female pelvic medicine and reconstruction, as well as decision aids available in the field. Key points Shared decision-making (SDM) is a management approach in which providers and patients work together using the best available evidence to make decisions that fit with patients’ own values and preferences. SDM improves patient knowledge of management options and satisfaction with decision-making. SDM can help to satisfy the legal and ethical recommendations for patient counselling. Decision aids are tools designed to help patients to make management decisions based on the information given by their care providers. Barriers to SDM can arise owing to patient factors, provider training or system failings.