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How Patients Make Decisions with Their Surgeons: The Role of Counseling and Patient Decision Aids

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Difficult Decisions in Thoracic Surgery

Abstract

Recent studies of patient decision making about surgical options that involve making trade-offs between benefits and harms underscore major gaps in decision quality. Following standard counseling, patients’ score D on knowledge tests and F on their understanding of the probabilities of benefits and harms. Moreover, there is a mismatch between the benefits and harms that patients’ value most and the option that is chosen. Patients participate in decision making less than they prefer; some have high levels of decisional discomfort which is an independent predictor of downstream dissatisfaction, regret, and the tendency to blame their doctor for bad outcomes. The underlying mechanisms explaining the poor decision quality with standard counseling is (1) patients’ difficulties recalling facts and understanding probabilities and (2) surgeons’ difficulties judging the values that patients’ place on benefits versus harms.

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Author information

Authors and Affiliations

  1. School of Nursing and Clinical Epidemiology Program, University of Ottawa and Ottawa Health Research Institute, Ottawa, ON, Canada

    Annette M. O’Connor RN, MScN, PhD

  2. Hôpital St-François d’Assise, Centre Hospitalier Universitaire de Québec, Québec, QC, Canada

    France Légaré MD, MSc, PhD, CCMF, FCMF

  3. School of Nursing, University of Ottawa, Ottawa, ON, Canada

    Dawn Stacey RN, MScN, PhD

Authors
  1. Annette M. O’Connor RN, MScN, PhD
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  2. France Légaré MD, MSc, PhD, CCMF, FCMF
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  3. Dawn Stacey RN, MScN, PhD
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Editor information

Editors and Affiliations

  1. Department of Surgery, The University of Chicago, Chicago, IL, USA

    Mark K. Ferguson MD (Professor and Head) (Professor and Head)

  2. Thoracic Surgery Service, The University of Chicago Hospitals, Chicago, IL, USA

    Mark K. Ferguson MD (Professor and Head) (Professor and Head)

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© 2007 Springer-Verlag London Limited

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O’Connor, A.M., Légaré, F., Stacey, D. (2007). How Patients Make Decisions with Their Surgeons: The Role of Counseling and Patient Decision Aids. In: Ferguson, M.K. (eds) Difficult Decisions in Thoracic Surgery. Springer, London. https://doi.org/10.1007/978-1-84628-474-8_5

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  • DOI: https://doi.org/10.1007/978-1-84628-474-8_5

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-84628-384-0

  • Online ISBN: 978-1-84628-474-8

  • eBook Packages: MedicineMedicine (R0)

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