Time for a paradigm shift in shared decision-making in trauma and emergency surgery? Results from an international survey

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.

MODERN ETIOLOGICAL STRUCTURE OF ACUTE GASTROENTEROCOLITIS IN THE SOUTHERN UKRAINE

The etiological structure of the acute diarrhoeal infections among the population of the Odessa region during 2015-2017 was analyzed. Based on the registered cases, an assessment of the frequency of hospitalization of sick persons from different age groups was undertaken. The most frequent pathogens from 18 detected bacterial causative agents were St. aureus, Kl. pneumoniae, Ps. aeruginosa, E. coli, Pr. vulgaris, Ent.cloacae. During 2016-2017 the mixed infection was detected in 54 fecal samples. Bacterial-virus associations were detected in 20 samples and were presented in St. aureus, Kl. pneumoniae, Ps. Aeruginosa and Rotavirus. During the summer period of 2016, the detection rate of rota-, noro-, adenovirus antigens in the examined fecal samples of adult patients was 13.60%. According to the results of genotyping of the circulating rotaviruses strains in 2016, strains G1P[8] (46.70%) and G3P[8] (26.70%) are most commonly detected.