Abstract
Background
Every day thousands of surgeons and patients negotiate their way through the complex process of decision-making about operative treatments. We conducted a series of qualitative studies, asking patients and surgeons to describe their experience and beliefs about informed decision-making and consent. This study focuses on surgeons’ views.
Methods
Open-ended interviews and focus group discussions were conducted with thoracic surgeons who treated esophageal cancer patients by esophagectomy, and general surgeons who routinely performed laparoscopic cholecystectomy. Their views were analyzed using a qualitative approach, grounded in the perspectives of the participants.
Results
Five dominant themes emerged from the analysis: (1) making informed decisions; (2) communicating information and confidence; (3) managing expectations and fears; (4) consent as a decision to trust; (5) commitment inspired by trust. These themes are illustrated by verbatim quotes from the surgeon interviews.
Conclusions
Surgeons carefully assess the risks and benefits of treatment before consenting to perform operative interventions. They are influenced by objective findings and by affective factors such as courage and the determination to survive expressed by their patients. They manage risks, doubts, and fears—both their patients’ and their own—relying on trust and commitment on both sides to ensure the success of the surgical mission. The trust of their patients has a strong influence on the surgeons’ decisions and actions.
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Acknowledgments
We are grateful to the surgeons who participated in the interviews and focus groups, which formed the basis for this analysis. Their views and experiences were generously shared, presenting the authentic voice of courageous caregivers. Any errors in interpreting their story are the responsibility of the authors. We are grateful for financial support of this research to the Physicians Services Inc. Foundation of Canada (Grant 98-09) and the Eugene Cesario Memorial Fund at the University of Toronto, to Deborah McKneally and Julie Roorda for editorial assistance and to Solomon Benatar, Jay Katz, and many other colleagues for thoughtful advice during the evolution of this research.
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McKneally, M.F., Martin, D.K., Ignagni, E. et al. Responding to Trust: Surgeons’ Perspective on Informed Consent. World J Surg 33, 1341–1347 (2009). https://doi.org/10.1007/s00268-009-0021-7
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DOI: https://doi.org/10.1007/s00268-009-0021-7