84 | Chapter 3 Patient involvement in SDM process and surgeon’s perspective (CPS) Based on the CPS scored, most patients (n=17, 47.2%) expressed a preference for a collaborative treatment choice, followed by a physician-controlled choice (n=11, 30.6%). Surgeons also predominantly favored a collaborated choice (n=16, 44.4%), with a patient-controlled choice (n=13, 36.1%) being the next most common option. In twenty-three cases (63.9%), the surgeon’s assumptions aligned with patient preferences for involvement, but in thirteen cases (36.1%), there was a mismatch. Among cases where surgeons assumed a patient-controlled approach (n=13), one patient actually preferred collaboration, while five patients favored a physician-controlled approach. Conversely, in cases where surgeons assumed a collaborative approach (n=15), one patient desired a patient-controlled approach, and two preferred a physician-controlled one. Additionally, when surgeons assumed patients preferred physician-controlled decision-making (n=7), four patients preferred a collaborative decision-making process. In nine of 42 consultations (21.4%), the way in which the consultation had taken place did not match the patient’s preferences. Seventeen of 42 (40.5%) patients preferred a collaborative approach to decision-making, but for five of 42 (11.9%) patients it felt like a patient-controlled choice, and for four it felt like a physician-controlled one. Table 3. CPS: Patient’s preferred and perceived involvement in SDM and concordance with surgeon’s perspective CPS items Preference of the patient N=36 How it went according to the patient N=34* What the surgeon thinks the patient prefers N=36 What the surgeon prefers N=36 Patient-controlled 8 (22.2%) 13 (38.2%) 13 (36.1%) 13 (36.1%) Collaborative 17 (47.2%) 8 (23.6%) 15 (41.7%) 16 (44.4%) Physician-controlled 11 (30.6%) 13 (38.2%) 8 (22.2%) 7 (19.5%) Note: *Missing data of two patients Associations with HN surgeons’ observed level of SDM Consultation time (β0.019, 95% CI 0.004 – 0.034, p=0.013), and a higher OPTIONscore of patients were positively correlated (β0.606, 95% CI 0.34 – 0.87, p<0.001) with HN surgeons’ observed level of SDM. No other significant associations were found. Additionally, no characteristics of surgeons were included in the univariate linear regression analysis due to the small number of participating surgeons.
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