Shared decision‐making for major surgery

We read with interest the article by Leung et al., setting out key recommendations for delivering shared decision-making and their integration into surgical pathways [1]. We commend the authors for emphasising the need to embed shared decision-making education into the curriculum and recognising the theory–practice gap. As part of a recent survey on the personality traits of anaesthetists undertaking regular, elective shared decision-making conversations, we analysed gaps in resident doctors' exposure to shared decision-making. Of 223 UK anaesthetists who completed the survey, 43 were non-consultant grades (29 resident doctors, 13 speciality grade doctors and one clinical fellow). Of the 29 resident doctors, only 13 reported undertaking regular, elective shared decision-making conversations (a minimum of once per month). For senior resident doctors (ST5–7), 12/20 surveyed reported little or no exposure to undertaking shared decision-making conversations. We acknowledge these findings are exploratory and based on self-reported exposure; however, they show a consistent signal across training grades. Although exploratory, this raises important questions as to how shared decision-making education is embedded into the current curriculum. Despite 2021 Royal College of Anaesthetists Curriculum formally including peri-operative medicine, shared-decision making and patient-centred peri-operative care as core competencies for resident doctors [2], our results would suggest there continues to be a mismatch between curriculum intent and clinical exposure. Limited exposure to shared decision-making conversations at stage 2 and 3 of anaesthetic training risks reinforcing the current model in which shared decision-making is either deferred to consultants or applied inconsistently. Given that anaesthetic residents contribute frequently to pre-operative assessment and peri-operative discussions, they are well placed to participate in shared decision-making and yet may be underutilised in this role. Our findings align with the observations that knowledge and confidence in shared decision-making does not translate consistently into practice and support the key recommendations for embedding the core skills for undertaking shared decision-making conversations into the curriculum [3]. Further work exploring barriers to resident doctors' involvement in shared decision-making would be valuable in informing implementation strategies. We commend the authors for advancing this important agenda and believe that integrating insights from training environments will be essential to achieving sustainable adoption of peri-operative shared decision-making.