Shared Decision Making for patients having surgery

Shared Decision Making is a process that helps patients to be more involved in decisions that are made about their health care. 

It involves a 2-way sharing of information. 

1. Your healthcare team will share information with you about what treatment options are appropriate for your specific situation. The options discussed will vary for each patient and may include surgery, radiotherapy, chemotherapy or treatments aimed at the relief of symptoms. The most appropriate treatment for you may involve a combination of these therapies. 
2. It also involves you sharing with your treating team what factors are important to you when making decisions about treatment options.

Based on the preferences that you have expressed, your healthcare team will then make a recommendation to you about which treatment option is most likely to help you achieve your goals. 

This process often works in partnership with our other programs here at Peter Mac which aim to improve your physical, emotional, nutritional and general health before your treatment. 

These include: 

• Prehabilitation 
• Cardiopulmonary exercise testing 
• Surgery School

Here at Peter Mac, the shared decision making process is usually made up of 3 steps: 

1. A primary Shared Decision Making Clinic appointment:

At this initial meeting, your medical journey up to that point will be reviewed with you. We will also explore the range of possible treatment options that might be appropriate in your specific situation. This could include surgery as well as other treatment options like chemotherapy, radiotherapy or therapies that focus on symptom control. At the same time, we would also like to learn more about you. This may include discussing what your life currently looks like, what you hope to achieve out of treatment and what is important to you. Understanding you in this way helps us to make more individualised treatment recommendations. 

2. A multidisciplinary team meeting:

This is a meeting for the different health care workers at Peter Mac who are involved in your care. This can include surgeons, anaesthetic doctors, physiotherapists specialist doctors (like cardiologists or kidney specialists) and intensive care doctors. In this meeting, your case will be reviewed and the potential risks and benefits of all appropriate treatments will be discussed. They will also discuss which treatment option might best align with what you want to achieve from treatment and what is important to you. This discussion is confidential and forms the basis of any recommendations that the team makes. You will not be present at this meeting. However, a verbal summary of the recommendations from this meeting will be shared with you at your follow up Shared Decision Making clinic appointment (see below). 

3. A secondary Shared Decision Making Clinic appointment:

At this second appointment, a summary of the discussion points and recommendations from the multidisciplinary meeting will be reviewed with you. We will then explore your thoughts about these suggestions. You will also be given the opportunity to clarify any details or ask any questions but you do not have to make any decisions about treatment at this point. 

Although the team will make a recommendation to you based on your expressed values and goals, ultimately the choice of treatment is a decision you will make together with your surgeon.

When you are booked in for a Shared Decision Making Clinic, you can expect a conversation with one or 2 senior doctors. In most circumstances, these will be senior anaesthetic doctors (Anaesthetists). Anaesthetists are often well placed to have these conversations as they lead the processes at Peter Mac to improve fitness and health before surgery. They also work closely with surgeons and have an intimate understanding of the potential risks and benefits of surgery. 

This first appointment usually takes about an hour. Sometimes, it is done on the same day as a cardiopulmonary exercise test or a Pre-Anaesthetic Clinic appointment or a surgical clinic appointment. 

Any subsequent Shared Decision Making clinic appointments may occur in person or via phone/telehealth depending on your location and circumstances. 

You don’t have to bring anyone with you to this appointment. However, many people find it helpful to bring along a family member or close friend. 

If you already have someone who you would trust to make medical decisions for you if you are not able to, then it would be important to bring this person to your appointment. This person is sometimes referred to as a Medical Treatment Decision Maker. For more information about this please click here.

If you have any Advance Care Planning documentation or Medical Power of Attorney documentation, then please bring these along to your appointment. 

An Advance Care Plan is a collection of documents that ensure people without the capacity to make decisions receive medical treatment that is consistent with their preferences and values. An Advance Care Plan is also sometimes called an Advance Directive or a Living Will. This Advance Care Plan can be used to assist your family, friends and doctors to make medical decision on your behalf if you are ever in a position where you are not able to effectively communicate for yourself. You can find out more information about an Advance Care Plan here.

Please watch the film at the top of this page. You may find it helpful to watch it a few times or together with family and friends. 

It may also be helpful for you to have a think about some of the following information:  

• How your illness has impacted your current quality of life 
• What you would consider a ‘good’ outcome of treatment
• What you would consider an ‘unacceptable’ outcome of treatment
• Any hopes or goals you have for the immediate or distant future 
• What a ‘good’ quality of life looks like for you