The impact and role of shared decision-making in surgical practice: A systematic review.

Abstract

Background: Shared decision-making (SDM) is a collaborative approach that integrates clinical evidence with patient values to guide healthcare decisions. Although widely promoted as a quality indicator, its adoption in surgical care remains variable. Understanding its impact and implementation in surgery is essential to improve patient-centred outcomes.

Methods: A systematic review with narrative synthesis was conducted in accordance with PRISMA guidelines and registered in PROSPERO (ID 1145717). MEDLINE, EMBASE, Ovid and Cochrane databases were searched for studies published between 1995 and 2025. Randomized trials and comparative observational studies evaluating shared decision-making (SDM) interventions in adult surgical patients were included. Two reviewers independently performed study screening, data extraction and quality assessment. Primary outcomes were patient-reported measures (satisfaction, perceived involvement, decisional conflict, and knowledge). Secondary outcomes included postoperative complications and length of stay. Risk of bias was assessed using the Newcastle-Ottawa Scale, and certainty of evidence was graded using the GRADE approach. Due to heterogeneity across interventions and surgical subspecialties, a narrative synthesis was performed.

Results: The search identified 4119 records, among which 29 studies met inclusion criteria. Most were randomized controlled trials or prospective cohorts, spanning orthopaedic, breast, colorectal, gynaecologic, vascular, and general surgery. SDM interventions were diverse, including decision aids, question prompt lists, smartphone applications, and surgeon-patient communication training. Compared with usual care, SDM consistently improved patient knowledge, involvement, satisfaction, and reduced decisional conflict. Evidence for clinical outcomes, such as complication rates or length of stay, was limited and inconsistent. Quality appraisal showed most studies were of moderate to high quality, although several pilot trials had small samples and limited generalizability.

Conclusions: SDM improves patient-centred outcomes in surgical practice, though its effect on clinical endpoints remains uncertain. The evidence highlights stronger benefits in elective than in emergency contexts, where time constraints and patient frailty limit feasibility. Standardized measurement tools, validated surgery-specific decision aids, and integration of digital technologies are needed to strengthen implementation. Broader institutional support and training in SDM communication should be prioritized to embed SDM as a routine component of surgical care.