# The involvement of anaesthetists and other healthcare professionals with surgeons in shared decision-making for adult patients contemplating surgery: a systematic review and narrative analysis

## TL;DR

This paper reviews how involving various healthcare professionals with surgeons helps patients decide about surgery, improving decision quality and outcomes.

## Contribution

The study provides a systematic review and analysis of multidisciplinary team involvement in surgical shared decision-making for adult patients.

## Key findings

- Multidisciplinary team shared decision-making improves decisional quality and reduces decisional conflict.
- High-risk patients are more likely to choose non-operative management with multidisciplinary input.
- Five features of effective multidisciplinary consultations were identified, including expert assessment and coordinated patient support.

## Abstract

Recognising the medical and surgical complexity of certain patient populations, perioperative pathways are evolving to incorporate multidisciplinary team perspectives, alongside surgeons, in shared decision-making. We aimed to synthesise the evidence base for multidisciplinary team shared decision-making.

We performed a systematic literature review accessing bibliographic databases (MEDLINE (using OVID), EMBASE, PsycINFO, Web of Science, CINAHL, and ProQuest), the international prospective register for systematic reviews (PROSPERO), the International Standard Randomised Control Trial Number Registry, and the King’s Fund Library Database.

Of 8727 citations, 271 were eligible for full-text review and 29 included in the final narrative synthesis. A wide variety of non-surgical healthcare professionals (e.g. anaesthetist, geriatrician, radiation oncologist, intensivist, specialist nurse, physiotherapist, psychologist, and social worker) and others (including peer support) participated in perioperative shared decision-making. Consultations were mainly structured sequentially or concomitantly with surgical consultations. Patients and clinicians generally responded positively to multidisciplinary team shared decision-making. Where measured, decisional quality was reported to have improved, and decisional conflict reduced. Studies of high-risk patients indicated that multidisciplinary team shared decision-making was more likely to result in non-operative management. We identified five features of these modes of multidisciplinary team shared decision-making consultation: identification of relevant experts required, expert multidisciplinary assessment, thorough consideration of alternative treatments, coordinated patient support, and additional consultation time.

Some surgical populations, as a function of the complexity of their medical, surgical, or both condition(s), would benefit from multidisciplinary team shared decision-making. Further research is required to understand the optimal organisation of this approach and the impact on patient and systems outcomes.

PROSPERO (CRD42025636328).