Time for a paradigm shift in shared decision-making in trauma and emergency surgery? Results from an international survey
Authors: Cobianchi Lorenzo , Dal Mas Francesca , Agnoletti Vanni , Ansaloni Luca , Biffl Walter , Butturini Giovanni , Campostrini Stefano , Catena Fausto , Denicolai Stefano , Fugazzola Paola , Martellucci Jacopo , Massaro Maurizio , Previtali Pietro , Ruta Federico , Venturi Alessandro , Woltz Sarah , Kaafarani Haytham M. , Loftus Tyler J. ,   the Team Dynamics Study Group, Aapoäÿlu Recayi , Abbott Kenneth Lyle , Abdelmalik Abubaker , Abebe Nebyou Seyoum , Abu-Zidan Fikri , Adam Yousif Abdallah Yousif , Adamou Harissou , Adamovich Dmitry Mikhailovich , Agresta Ferdinando , Agrusa Antonino , Akin Emrah , Alessiani Mario , Alexandrino Henrique , Bidoli Chiara , Ali Syed Muhammad , Mihai Vasilescu Alin , Almeida Pedro Miguel , Al-Shehari Mohammed Mohammed , Altomare Michele , Amico Francesco , Ammendola Michele , Andreuccetti Jacopo , Anestiadou Elissavet , Annicchiarico Alfredo , Antonelli Amedeo , Aparicio-Sanchez Daniel , Ardito Antonella , Argenio Giulio , Arvieux Catherine Claude , Arvieux Catherine , Askevold Ingolf Harald , Atanasov Boyko Tchavdarov , Augustin Goran , Awad Selmy Sabry , Bacchiocchi Giulia , Bagnoli Carlo , Bahouth Hany , Baili Efstratia , Bains Lovenish , Baiocchi Gian Luca , Bala Miklosh , Balaguà© Carmen , Balalis Dimitrios , Baldini Edoardo , Baraket oussama , Baral Suman , Barone Mirko , Gonzãlez Barranquero Alberto , Barreras Jorge Arturo , Bass Gary Alan , Bayhan Zulfu , Bellanova Giovanni , Ben-Ishay Offir , Bert Fabrizio , Bianchi Valentina , Biancuzzi Helena , Radulescu Raluca Bievel , Bignell Mark Brian , Biloslavo Alan , Bini Roberto , Bissacco Daniele , Boati Paoll , Boddaert Guillaume , Bogdanic Branko , Bombardini Cristina , Bonavina Luigi , Bonomo Luca , Bottari Andrea , Bouliaris Konstantinos , Brachini Gioia , Brillantino Antonio , Brisinda Giuseppe , Bulanauca Maloni Mamada , Buonomo Luis Antonio , Burcharth Jakob , Buscemi Salvatore , Calabretto Francesca , Calini Giacomo , Calu Valentin , Campanile Fabio Cesare , Campo Dall’Orto Riccardo , Campos-Serra Andrea , Carvas Joao Miguel , Cascella Marco , Pattacini Gianmaria Casoni , Celentano Valerio , Centonze Danilo Corrado , Ceresoli Marco , Chatzipetris Dimitrios , Chessa Antonella , Chiarello Maria Michela , Chirica Mircea , Chooklin Serge , Chouliaras Christos , Chowdhury Sharfuddin , Cianci Pasquale , Cillara Nicola , Cimbanassi Stefania , Cioffi Stefano Piero Bernardo , Colãis-Ruiz Enrique , Colak Elif , Conti Luigi , Coppola Alessandro , de Sa Tiago Correia , Costa Silvia Dantas , Cozza Valerio , Curro’ Giuseppe , Dabekaussen Kirsten Felicia Ann-Sophie Aimee , D’acapito Fabrizio , Damaskos Dimitrios , D’Ambrosio Giancarlo , Das Koray , Davies Richard Justin , de Beaux Andrew Charles , De Lebrusant Fernandez Sara Patricia , De Luca Alessandro , De Simone Belinda , De Stefano Francesca , Degrate Luca , Demetrashvili Zaza , Demetriades Andreas Kyriacou , Detanac Dzemail Smail , Dezi Agnese , Di Buono Giuseppe , Carlo Isidoro-D. I. , Di Lascio Pierpaolo , Di Martino Marcello , Di Saverio Salomone , Diaconescu Bogdan , Diaz Jose J. , Dibra Rigers , Dimitrov Evgeni Nikolaev , Dinuzzi Vincenza Paola , Dios-Barbeito Sandra , Diyani Jehangir Farman Ali , Dogjani Agron , Domanin Maurizio , D’Oria Mario , Munoz-Cruzado Virginia Duran , East Barbora , Ekelund Mikael , Ekwen Gerald Takem , Elbaih Adel Hamed , Elhadi Muhammed , Enninghorst Natalie , Ernisova Mairam , Escalera-Antezana Juan Pablo , Esposito Sofia , Esposito Giuseppe , Estaire-Gãmez Mercedes , Farã Camilla Nikita , Farre Roser , Favi Francesco , Ferrario Luca , Ferrario di Tor Vajana Antonjacopo , Filisetti Claudia , Fleres Francesco , Fonseca Vinicius Cordeiro , Forero-Torres Alexander , Forfori Francesco , Fortuna Laura , Fradelos Evangelos , Fraga Gustavo P. , Fransvea Pietro , Frassini Simone , Frazzetta Giuseppe , Frigerio Isabella , Frountzas Maximos , Gachabayov Mahir , Galeiras Rita , Garcãa Belen Matãas , Garcia Vazquez Alain , Gargarella Simone , Garzali Ibrahim Umar , Ghannam Wagih Mommtaz , Ghazi Faiz Najmuddin , Gillman Lawrence Marshall , Gioco Rossella , Giordano Alessio , Giordano Luca , Giove Carlo , Giraudo Giorgio , Giuffrida Mario , Capponi Michela Giulii , Gois Emanuel , Gomes Carlos Augusto , Gomes Felipe Couto , Gonsaga Ricardo Alessandro Teixeira , Gonullu Emre , Goosen Jacques , Goranovic Tatjana , Gracia-Roman Raquel , Graziano Giorgio Maria Paolo , Griffiths Ewen Alexander , Guagni Tommaso , Hadzhiev Dimitar Bozhidarov , Haidar Muad Gamil , Hamid Hytham K. S. , Hardcastle Timothy Craig , Hayati Firdaus , Healey Andrew James , Hecker Andreas , Hecker Matthias , Garcia Edgar Fernando Hernandez , hodonou Adrien Montcho , huaman Eduardo cancio , Huerta Martin , Ibrahim Aini Fahriza , Ibrahim Basil Mohamed Salabeldin , Ietto Giuseppe , Inama Marco , Ioannidis Orestis , Isik Arda , Ismail Nizar , Ismail Azzain Mahadi Hamid , Jailani RUHI Fadzlyana , Jang Ji Young , Kalfountzos Christos , Kalipershad Sujala Niatarika Rajsain , Kaouras Emmanouil , Kaplan Lewis Jay , Kara Yasin , Karamagioli Evika , Karamarkovia Aleksandar , Katsaros Ioannis , Kavalakat Alfie J. , Kechagias Aristotelis , Kenig Jakub , Kessel Boris Juli , Khan Jim S. , Khokha Vladimir , Kim Jae Il , Kirkpatrick Andrew Wallace , Klappenbach Roberto , Kobe Yoshiro , Lymperis Efstratios Kofopoulos , Kok Kenneth Yuh Yen , Kong Victor , Korkolis Dimitris P. , Koukoulis Georgios , Kovacevic Bojan , Kruger Vitor Favali , Kryvoruchko Igor A. , Kurihara Hayato , Kuriyama Akira , Landaluce-Olavarria Aitor , Lapolla Pierfrancesco , Licari Leo , Lisi Giorgio , Litvin Andrey , Lizarazu Aintzane , Bayo Heura Llaquet , Lohsiriwat Varut , Moreira Claudia Cristina Lopes , Lostoridis Eftychios , Luna Agustãn Tovar , Luppi Davide , V. Gustavo Miguel Machain , Maegele Marc , Maggiore Daniele , Magnone Stefano , Maier Ronald V. , Maier Ronald V. , Major Piotr , Manangi Mallikarjuna , manetti andrea , Mantoglu Baris , Marafante Chiara , Mariani Federico , Marinis Athanasios , Mariot EvandroAntonio Sbalcheiro , Marseglia Giuseppe Roberto , Martãnez-Pãrez Aleix , Martines Gennaro , Perez Aleix Martinez , Martino Costanza , Mascagni Pietro , Massalou Damien , Matãas-Garcãa Belãn , Mazzarella Gennaro , Mazzarolo Giorgio , Melo Renato Bessa , Mendoza-Moreno Fernando , Meric Serhat , Meyer Jeremy , Miceli Luca , Michalopoulos Nikolaos V. , Milana Flavio , Mingoli Andrea , Mishra Tushar S. , Mohamed Muyed , Mohamed Musab Isam Eldin Abbas , Mohamedahmed Ali Yasen , Mohammed Mohammed Jibreel Suliman , Mohan Rajashekar , Moore Ernest E. , Morales-Garcia Dieter , Muhrbeck Mãns , Mulita Francesk , Mustafa Sami Mohamed Siddig , Muttillo Edoardo Maria , Naimzada Mukhammad David , Navsaria Pradeep H. , Negoi Ionut , Nespoli Luca , Nguyen Christine , Nidaw Melkamu Kibret , Nigri Giuseppe , Nikolopoulos Ioannis , O’Connor Donal Brendan , Ogundipe Habeeb Damilola , Oliveri Cristina , Olmi Stefano , Ong Ernest Cun Wang , Orecchia Luca , Osipov Aleksei V. , Othman Muhammad Faeid , Pace Marco , Pacilli Mario , Pagani Leonardo , Palomba Giuseppe , Pantalone Desire’ , Panyko Arpad , Paolillo Ciro , Papa Mario Virgilio , Papaconstantinou Dimitrios , Papadoliopoulou Maria , Papadopoulos Aristeidis , Papis Davide , Pararas Nikolaos , Parreira Jose Gustavo , Parry Neil Geordie , Pata Francesco , Patel Tapan , Paterson-Brown Simon , Pavone Giovanna , Pecchini Francesca , Pellino Gianluca , Pelloni Maria , Peloso Andrea , del Pozo Eduardo Perea , Pereira Rita Goncalves , Pereira Bruno Monteiro , perez Aintzane Lizarazu , Perra Teresa , Perrone Gennaro , Pesce Antonio , Petagna Lorenzo , Petracca Giovanni , Phupong Vorapong , Picardi Biagio , Picciariello Arcangelo , Piccoli Micaela , Piccolo Daniele , Picetti Edoardo , Pikoulis Pikoulis Emmanouil , Pintar Tadeja , Pirozzolo Giovanni , Piscioneri Francesco , Podda Mauro , Porcu Alberto , Privitera Francesca , Punzo Clelia , Quaresima Silvia , Quiodettis Martha Alexa , Qvist Niels , Rahim Razrim , de Almeida Filipe Ramalho , Ramely Rosnelifaizur Bin , Rasa Huseyin Kemal , Reichert Martin , Reinisch-Liese Alexander , Renne Angela , Riccetti Camilla , Rodriguez-Luna Maria Rita , Roizblatt Daniel , Romanzi Andrea , Romeo Luigi , Roscio Francesco Pietro Maria , Rosnelifaizur Ramely Bin , Rossi Stefano , Rubiano Andres M. , Ruiz-Ãšcar Elena , Sakakushev Boris Evgeniev , Salamea Juan Carlos , Sall Ibrahima , Samarakoon Lasitha Bhagya , Sammartano Fabrizio , Arteaga Alejandro Sanchez , Sanchez-Cordero Sergi , Santoanastaso Domenico Pietro Maria , Sasia Diego , Sato Norio , Savchuk Artem , Sawyer Robert Grant , Scaioli Giacomo , Schizas Dimitrios , Sebastiani Simone , Seeliger Barbara , Lohse Helmut Alfredo Segovia , Seretis Charalampos , Sermonesi Giacomo , Serradilla-Martin Mario , Shelat Vishal G. , Shlyapnikov Sergei , Sidiropoulos Theodoros , Simoes Romeo Lages , Siragusa Leandro , Siribumrungwong Boonying , Slavchev Mihail , Solaini Leonardo , soldini gabriele , Sopuev Andrey , Soreide Kjetil , Sovatzidis Apostolos , Stahel Philip Frank , Strickland Matt , Sultan Mohamed Arif Hameed , Sydorchuk Ruslan , Sydorchuk Larysa , Syed Syed Muhammad Ali Muhammad , Syed Ali Muhammad , Tallon-Aguilar Luis , Tamburini Andrea Marco , Tamini Nicolò , Tan Edward C. T. H. , Tan Jih Huei , Tarasconi Antonio , Tartaglia Nicola , Tartaglia Giuseppe , Tartaglia Dario , Taylor John Vincent , Tebala Giovanni Domenico , Gonsaga Ricardo Alessandro Teixeira , Teuben Michel , Theodorou Alexis , Tolonen Matti , Tomasicchio Giovanni , Toro Adriana , Torre Beatrice , Triantafyllou Tania , Trigiante Trigiante Giuseppe , Tripepi Marzia , Trostchansky Julio , Tsekouras Konstantinos , Turrado-Rodriguez Victor , Tutino Roberta , Uccelli Matteo , Uchikov Petar Angelov , Ugarte-Sierra Bakarne , Ukkonen Mika Tapani , Vailas Michail , Vassiliu Panteleimon G. , Vazquez Alain Garcia , Vazquez Rita Galeiras , Verde Juan Ezequiel , Verde Juan Manuel , Veroux Massimiliano , Viganò Jacopo , Vilallonga Ramon , Visconti Diego , Vittori Alessandro , Waledziak Maciej , Wannatoop Tongporn , Widmer Lukas Werner , Wilson Michael Samuel James , Wong Ting Hway , Xenaki Sofia , Yu Byungchul , Yule Steven , Zachariah Sanoop Koshy , Zacharis Georgios , Zaghi Claudia , Zakaria Andee Dzulkarnaen , Zambrano Diego A. , Zampitis Nikolaos , Zampogna Biagio , Zanghã Simone , Zapsalis Konstantinos , Zattoni Fabio , Zese Monica , Farre Silvia Pãrez , Atanasov Boyko Tchavdarov , Pegoraro Veronica , Zantedeschi Maristella , Reitano Elisa , Pizzocaro Erica 
Published: February 2023

Abstract
Background
Shared decision-making (SDM) between clinicians and patients is one of the pillars of the modern patient-centric philosophy of care. This study aims to explore SDM in the discipline of trauma and emergency surgery, investigating its interpretation as well as the barriers and facilitators for its implementation among surgeons.

Methods
Grounding on the literature on the topics of the understanding, barriers, and facilitators of SDM in trauma and emergency surgery, a survey was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was sent to all 917 WSES members, advertised through the society’s website, and shared on the society’s Twitter profile.

Results
A total of 650 trauma and emergency surgeons from 71 countries in five continents participated in the initiative. Less than half of the surgeons understood SDM, and 30% still saw the value in exclusively engaging multidisciplinary provider teams without involving the patient. Several barriers to effectively partnering with the patient in the decision-making process were identified, such as the lack of time and the need to concentrate on making medical teams work smoothly.

Discussion
Our investigation underlines how only a minority of trauma and emergency surgeons understand SDM, and perhaps, the value of SDM is not fully accepted in trauma and emergency situations. The inclusion of SDM practices in clinical guidelines may represent the most feasible and advocated solutions.