Promoting shared decision-making in the surgical realm From the surgeons’ preferred treatment for patients to the patients’ preferred treatment for surgery

To improve the quality of healthcare. Equality between doctor and patients is becoming increasingly important. In our modern society, the ethical principle that patients have the right to be better involved in the decision-making process regarding their health issues gets more recognition, while at the same time an increasing number of treatment options has become available.
The aim of this thesis was to explore the current level of shared decision-making (SDM) and risk communication in the out-patient clinic, and to improve this level by developing and implementing SDM and risk communication tools. An essential step in the process of SDM, is the communication about the possible treatment options with their pros and cons. Because visual presentation of information may increase patient comprehension, a web-based, publicly available (www.mapping.nu) application that provides graphical representation of numerical benefits and risk of surgical treatment options was developed.
Besides the MAPPING app we developed various decision support tools (DSTs). DSTs were developed for four vascular disorders, i.e., patients with an abdominal aortic aneurysm (AAA), carotid artery disease (CAD), intermittent claudication (IC) and varicose veins (VV). The various support tools included patient decision aids, consultation cards, and decision cards. Besides the usual content of DAs, the DAs we developed contain 3D-animations of each of the treatment options to better explain and illustrate what these treatments involve. The patients go through the decision aid prior to the decision-making consultation in order to enter this conversation as well prepared as possible.
The OVIDIUS trial showed that the introduction of decision support tools improves the degree of shared decision-making, the knowledge about treatment options and that patients opt less often for invasive treatments. In addition, it was seen that the online decision aid was most effective for patients and that the shared decision-making training was the most effective for clinicians.