Abstract
Advances in the treatment of endocrine diseases have brought about an array of choices for surgeons and patients. Surgical decision-making involves a clinical recommendation as well as the process of “shared decision-making” in order to reach the best outcome for a particular patient. This first part of this chapter will discuss factors related to surgical recommendations, the use of evidence and the quality of recommendations. The second part will focus on key elements of shared decision and informed consent such as disclosure and understanding, and highlight patient and surgeon factors which affect this process. A model for ethical decision-making that takes into account medical indications, patient preferences, quality of life and contextual features is described. Special issues in surgical decision-making discussed such as genetics, pediatrics, and end-of-life decision-making are also considered.
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References
Hall JC, Ellis C, Hamdorf J. Surgeons and cognitive processes. Br J Surg. 2003;90:10–6.
Francis DMA. Surgical decision making. ANZ J Surg. 2009;79:886–91.
Bernstein M, Jain VK. Ethical decision-making. In: Ammar A, Bernstein M, editors. Neurosurgical ethics in practice: value-based medicine. Berlin: Springer; 2014.
Horng S, Miller F. Is placebo surgery unethical? N Engl J Med. 2002;347:137–9.
Carling T, Carty SE, Ciarleglio MM, Cooper DS, Doherty GM, Kim LT, et al. American Thyroid Association design and feasibility of a prospective randomized controlled trial of prophylactic central lymph node dissection for papillary thyroid carcinoma. Thyroid. 2012;22:237–44.
Guyatt G, Haynes B, Jaeschke R, Cook DJ, Green L, Naylor CD, et al. Users’ guides to the medical literature XXV. Evidence-based medicine: principles for applying the users’ guides to patient care. J Am Med Assoc. 2000;284:1290–6.
Lacaine F. Evidence-based medicine in surgical decision making. World J Surg. 2005;29:588–91.
Plato. The laws. Taylor AE, translator. London: Dent; 1934. p. 104–5.
Siegler M. Searching for moral certainty in medicine: a proposal for a new model of the doctor-patient encounter. Bull N Y Acad Med. 1981;57:56–69.
National Research Council. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academies Press; 2001.
Barry MJ, Edgman-Levitan S. Shared decision making – the pinnacle of patient-centred care. N Engl J Med. 2012;366:780–1.
President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Making health care decisions. A report on the ethical and legal implications of informed consent in the patient-practitioner relationship, vol. 1; 1982. p. 31–9.
Jonsen AR, Siegler M, Winslade WJ. Clinical ethics: a practical approach to ethical discussions in clinical medicine. 7th ed. New York: McGraw-Hill Medical; 2010.
McCullough LB, Jones JW, Brody BA. Informed consent: autonomous decision making of the surgical patient. In: McCullough LB, Jones JW, Brody BA, editors. Surgical ethics. New York: Oxford; 1998. p. 15–37.
Faden RR, Beauchamp TL. A history and theory of informed consent. New York: Oxford; 1986.
Rosovsky R. Consent to treatment: a practical guide. Boston: Little, Brown; 1984.
Beauchamp TL, Childress JF. Principles of biomedical ethics. 6th ed. New York: Oxford; 2009.
Siegler M. Pascal’s wager and the hanging of crepe. N Engl J Med. 1975;23:853–7.
Stacey D, Bennett CL, Barry MJ, Col NF, Eden KB, Holmes-Rovner M, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2011;10:CD001431.
Billings J, Zeitel L, Lukomnik J, Blank L, Newman AE, Carey TS. Impact of socioeconomic status on hospital use in New York City. Health Aff (Millwood). 1993;12:162–73.
Hofer TP, Wolfe RA, Tedeschi PJ, McMahon PJ. Use of community versus individual socioeconomic data in predicting variation in hospital use. Health Serv Res. 1998;33:243–59.
Cooper RA, Cooper MA, McGinley EL, Fan X, Rosenthal JT. Poverty, wealth and health care utilization: a geographic assessment. J Urban Health. 2012;89:828–47.
Wilson NP, Wilson FP, Neuman M, Epstein A, Bell R, Armstrong K, et al. Determinants of surgical decision making: a national survey. Am J Surg. 2013;206:970–8.
Rosenthal SM, Angelos P, Cooper DS, Fassler C, Finder SG, Hays MT, et al. Clinical and professional ethics guidelines for the practice of thyroidology. Thyroid. 2013;23:1203–10.
Devon KM, Lerner-Ellis JP, Ganai S, Angelos P. Ethics and genomic medicine, how to navigate decisions in surgical oncology. J Surg Oncol. 2015;111:1–6.
Rosenthal MS, Diekema DS. Pediatric ethics guidelines for hereditary medullary thyroid cancer. Int J Pediatr Endocrinol. 2011;2011:847603.
Green RC, Berg JS, Grody WW, et al. ACMG recommendations for reporting of incidental findings in clinical exome and genome sequencing. Genet Med. 2013;15:565–74.
American College of Medical Genetics and Genomics. Incidental findings in clinical genomics: a clarification. Genet Med. 2013;15:664–6.
Sulmasy DP, Snyder JD. Substituted interests and best judgments. An integrated model of surrogate decision making. J Am Med Assoc. 2010;304:1946–7.
Peabody FW. The care of the patient. J Am Med Assoc. 1927;88:877–82.
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Devon, K. (2018). Decision-Making from the Surgeon’s Perspective. In: Angelos, P., Grogan, R. (eds) Difficult Decisions in Endocrine Surgery. Difficult Decisions in Surgery: An Evidence-Based Approach. Springer, Cham. https://doi.org/10.1007/978-3-319-92860-9_3
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DOI: https://doi.org/10.1007/978-3-319-92860-9_3
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