Fundamentals of Shared Decision-Making in Surgery

Abstract Shared decision-making (SDM) is a cornerstone of patient-centered care, particularly in colorectal surgery where treatment decisions often involve complex tradeoffs. This review outlines the principles, benefits, and challenges of SDM in surgical contexts, emphasizing its role in aligning clinical decisions with patient values. SDM enhances patient knowledge, reduces decisional conflict and regret, and improves satisfaction and adherence. It also offers systemic benefits, including reduced preference-sensitive surgeries and potential cost savings. Despite its promise, barriers such as limited health literacy, time constraints, and clinician discomfort with uncertainty hinder implementation. The review highlights validated tools and frameworks for studying SDM and explores the evolving role of decision aids in colorectal cancer care. Future research should focus on pragmatic, mixed-methods trials, and integration of SDM metrics into clinical workflows. Advancing SDM in colorectal surgery requires sustained efforts in clinician training, patient engagement, and culturally sensitive communication strategies.