Medical Decision-Making Research in Surgery

Abstract

As surgeons, we make highly challenging decisions every day about whether or not to operate on a patient, and which operation to do. Some of these decisions are challenging because they involve tradeoffs among high-stake risks and benefits, such as risk of stroke or restoration of bowel continuity. Other decisions are challenging because they involve deeply personal issues for the patient, such as continence or breast appearance. The ability of surgeons and patients to make these decisions has important implications for health outcomes, including quality of life and health care resource utilization. The science of evaluating, facilitating, and intervening on medical decisions is a relatively young field, which has evolved from other disciplines, including psychology, economics, health behavior, and engineering.

Decision sciences encompass a broad range of research – from investigating the process of patient decision-making, to the development of patient decision-aids and informing provider decision-making with simulation disease modeling. This chapter describes the theory behind this growing field as well as applications in surgical research. It first describes decision-making from the patient perspective and then explains how decision-making by a provider or payer can be informed by decision analysis and comparative-effectiveness research.