Bougeard Anne-Marie, Nair Ashwati, Santhirapala Ramai
ST7 Anaesthesia, University Hospitals Plymouth, UK.
Fifth Year Medical Student, GKT School of Medical Education, King's College London, UK.
PEC Innov. 2023 Jun 19;3:100181. doi: 10.1016/j.pecinn.2023.100181. eCollection 2023 Dec 15.
Decision making about high-risk surgery can be complex, particularly when outcomes may be uncertain. Clinicians have a legal and ethical responsibility to support decision making which fits with patients' values and preferences. In the UK, preoperative assessment and optimisation is led by Anaesthetists in clinic several weeks prior to planned surgery. Training in supporting shared decision making (SDM) has been identified as an area of need among UK anaesthetists with leadership roles in perioperative care.
We describe adaptation of a generic SDM workshop to perioperative care, in particular to decisions on high-risk surgery, and its delivery to UK healthcare professionals over a two-year period. Feedback from workshops were thematically analysed. We explored further improvements to the workshop and ideas for development and dissemination.
The workshops were well received, with high satisfaction for techniques used, including video demonstrations, role-play and discussions. Thematic analysis identified a desire for multidisciplinary training and training in using patient aids.
Qualitative findings suggest workshops were considered useful with perceived improvement in SDM awareness, skills and reflective practice.
This pilot introduces a new modality of training in the perioperative setting providing physicians, particularly Anaesthetists, with previously unavailable training needed to facilitate complex discussions.
高风险手术的决策可能很复杂，尤其是当结果不确定时。临床医生有法律和道德责任支持符合患者价值观和偏好的决策。在英国，术前评估和优化由麻醉师在计划手术前几周的门诊中主导。支持共同决策（SDM）的培训已被确定为在围手术期护理中担任领导角色的英国麻醉师的一个需求领域。
我们描述了一个通用的SDM研讨会如何适应围手术期护理，特别是关于高风险手术的决策，以及在两年时间内向英国医疗保健专业人员提供该研讨会的情况。对研讨会的反馈进行了主题分析。我们探讨了对该研讨会的进一步改进以及开发和传播的想法。
这些研讨会受到好评，对所使用的技术，包括视频演示、角色扮演和讨论，满意度很高。主题分析确定了对多学科培训和使用患者辅助工具培训的需求。
定性研究结果表明，这些研讨会被认为是有用的，在SDM意识、技能和反思性实践方面有明显改善。
这项试点在围手术期环境中引入了一种新的培训方式，为医生，特别是麻醉师提供了促进复杂讨论所需的以前无法获得的培训。
