Developing skills for evidence-based surgery: ensuring that patients make informed decisions.

Ensuring that the surgical decisions made by and with patients are fully informed is a challenge. Doctors and patients must work together, and to be successful they need support in the form of knowledge management and decision aids. This article emphasizes the importance of eliciting and honoring patients' personal valuations of alternative future health states, their attitudes to the specific risks and risk differences that are central to surgical decisions,and their attitudes to time trade-offs. The skills and habits necessary to accomplish this critical objective begin with nothing less than a genuine concern for patients and an ability to relate to the unique meaning that the present illness and its treatment have in their lives.