Perioperative complications chapter: Shared decision-making and informed consent

The practice of anesthesiology has grown remarkably safer, but complications ranging from minor to catastrophic may still occur. Improvements in patient safety have made surgery and anesthesia both commonplace and routine. The perioperative process, which classically began with admission to the hospital the night before the day of surgery, has been condensed into the efficient and increasingly cost-effective process of outpatient surgery. Patient confidence and comfort with this process has much to do with openness and communication on behalf of anesthesiologists and surgeons which did not always exist. Informed consent acknowledges the patient's individual autonomy and right to decide what medical or surgical interventions should be a part of his or her health care. A patient may elect to pursue a certain treatment when he or she is determined to have decision-making capacity; risks, benefits, and alternatives to the proposed treatment have been adequately disclosed; and the decision to pursue treatment is voluntary, or free of external coercion. Shared decision-making builds on the foundation of informed consent. It broadens the discussion to include the patient's goals of care, beliefs, and expectations in context with the physician's expert recommendation and experience. While perhaps most essential in high-risk operations and medically complex patients, shared decision-making is becoming increasingly recognized as a valuable tool for all patients in the perioperative process. Benefits of shared decision-making include increased patient satisfaction, cost savings, and decreased litigation. Many institutions across the country have implemented multidisciplinary care teams to evaluate complex patients preoperatively, guide the decision-making process, plan for both postoperative care and unanticipated outcomes, and establish advanced directives. Informed consent and shared decision-making coupled with evidence-based medicine are an increasingly essential aspect of the patient-centered perioperative process.