Shared decision-making in the treatment of uncomplicated gallstone disease: A cross-sectional pilot study.

Abstract

Background and aims: Shared decision-making (SDM) is increasingly emphasized in clinical guidelines. For uncomplicated gallstone disease, both surgical and conservative strategies are considered safe, making patient preferences central to treatment selection. This study assessed the extent of patient involvement in decision-making regarding treatment for uncomplicated gallstone disease.

Methods: In this prospective pilot study conducted at a surgical outpatient clinic in Norway, all referred patients with uncomplicated gallstone disease were invited to participate. Video-recorded consultations were independently evaluated by two expert raters. Surgeons, patients, and experts completed the MAPPIN-SDM questionnaire. The MAPPIN-SDM score is calculated as the mean of 11 items (0-4), with higher scores indicating greater SDM.

Results: Of 34 eligible patients, 26 were included; 68% were women, and the mean age was 47.8 years (SD = 16.1). The overall mean MAPPIN-SDM score was 2.6 (SD = 0.48). Patients (mean = 3.5, SD = 0.48) and surgeons (mean = 2.9, SD = 0.56) rated the level of SDM higher than external observers (mean = 1.55, SD = 0.65; p < 0.001). Fourteen patients (54%) ultimately underwent surgery. Their average MAPPIN-SDM score was significantly higher than that of managed conservatively (2.89 versus 2.28, p < 0.001).

Conclusion: This study demonstrates a moderate level of SDM in consultations for uncomplicated gallstone disease but reveals considerable discrepancies between patient/surgeon perceptions and observer assessments. Higher SDM scores were associated with the choice of surgery. These findings highlight the need for targeted strategies to improve the quality and consistency of SDM in the management of uncomplicated gallstone disease.