From the Department of Anesthesiology, Mayo Clinic, Jacksonville, Florida.
Division of Management Consulting, Department of Anesthesia, University of Iowa, Iowa City, Iowa.
Anesth Analg. 2018 Apr;126(4):1249-1256. doi: 10.1213/ANE.0000000000002273.
Studies of shared (patient-provider) decision making for elective surgical care have examined both the decision whether to have surgery and patients' understanding of treatment options. We consider shared decision making applied to case scheduling, since implementation would reduce labor costs.
Study questions were presented in sequence of waiting times, starting with 4 workdays. "Assume the consultant surgeon (ie, the surgeon in charge) you met in clinic did not have time available to do your surgery within the next 4 workdays, but his/her colleague would have had time to do your surgery within the next 4 workdays. Would you have wanted to discuss with a member of the surgical team (eg, the scheduler or the surgeon) the availability of surgery with a different, equally qualified surgeon at Mayo Clinic who had time available within the next 4 workdays, on a date of your choosing?" There were 980 invited patients who underwent lung resection or cholecystectomy between 2011 and 2016; 135 respondents completed the study and 6 respondents dropped out after the study questions were displayed.
The percentages of patients whose response to the study questions was "4 days" were 58.8% (40/68) among lung resection patients and 58.2% (39/67) among cholecystectomy patients. The 97.5% 2-sided confidence interval for the median maximum wait was 4 days to 4 days. Patients' choices for the waiting time sufficient to discuss having another surgeon perform the procedure did not differ between procedures (P = .91). Results were insensitive to patients' sex, age, travel time to hospital, or number of office visits before surgery (all P ≥ .20).
Our results indicate that bringing up the option with the patient of changing surgeons when a colleague is available and has the operating room time to perform the procedure sooner is being respectful of most patients' individual preferences (ie, patient-centered).
关于择期手术护理的共同（医患）决策的研究，既考察了是否进行手术的决策，也考察了患者对治疗方案的理解。我们考虑将共同决策应用于病例安排，因为实施这一方案可以降低劳动力成本。
研究问题按照等待时间的顺序呈现，首先是 4 个工作日。“假设您在诊所遇到的顾问外科医生（即负责的外科医生）在接下来的 4 个工作日内没有时间为您做手术，但他/她的同事在接下来的 4 个工作日内有时间为您做手术。您是否希望与 Mayo 诊所的一名不同的、同样合格的外科医生讨论手术的可能性，该医生在接下来的 4 个工作日内有时间，并且可以在您选择的日期进行手术？”2011 年至 2016 年间，共有 980 名接受肺切除术或胆囊切除术的患者受邀参加了这项研究；135 名受访者完成了研究，6 名受访者在研究问题显示后退出。
对研究问题回答“4 天”的患者百分比为肺切除术患者 58.8%（40/68），胆囊切除术患者 58.2%（39/67）。中位数最长等待时间的 97.5%双侧置信区间为 4 天至 4 天。不同手术患者对有另一名外科医生进行手术的足够等待时间的选择没有差异（P =.91）。患者的性别、年龄、前往医院的旅行时间或手术前的就诊次数（所有 P ≥.20）对结果没有影响。
我们的结果表明，当有同事有空并有手术室时间更快地进行手术时，向患者提出改变外科医生的选择是尊重大多数患者的个人偏好（即患者为中心）。
