Decisional conflict in surgical patients: Should surgeons care?

Decisional conflict in surgical patients: Should surgeons care?

Can J Surg 2019;62(3):211-213 | PDF

Mélissa Roy, MDCM; Christine B. Novak, PT, PhD; David R. Urbach, MD, MSc; Steven J. McCabe, MD, MSc; Herbert P. von Schroeder, MD, MSc; Karen Okrainec, MD, MSc


Decisional conflict represents a state of uncertainty regarding an action one must take. It is a concept inherent to shared decision-making and can help promote high-quality and patient-centred decisions in surgical care, leading to better outcomes. Specific elements may cause more uncertainty or decisional conflict for patients: lack of knowledge about risks and benefits, poorly defined personal values about the importance of those risks and benefits, perception of a lack of support, unpredictable outcomes, or the impression that an inadequate decision has been made. Decisional conflict can be measured in the surgical setting using the 16-item validated patient-reported Decisional Conflict Scale (DCS). Better understanding of the reasons behind high decisional conflict can help surgeons support high-quality decisions and lead to more satisfactory outcomes and less decisional regret.

Accepted Sept. 19, 2018

Affiliations: From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ont. (Roy, Novak, McCabe, Schroeder); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont. (Roy, Urbach, Okrainec); the Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ont. (Urbach); and the Division of Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ont. (Okrainec).

Funding: The contents of this article were developed under a grant from the Canadian Institutes of Health Research (CIHR), the Frederick Banting and Charles Best Canada Graduate Scholarship, awarded to support Mélissa Roy’s graduate degree.

Competing interests: None declared.

Contributors: All authors contributed substantially to the conception, writing and revision of this article and approved the final version for publication.

DOI: 10.1503/cjs.003218

Correspondence to: M. Roy, Division of Plastic and Reconstructive, Surgery, University of Toronto, The Rotman/Stewart Building, 149 College St, 5th Floor, Suite 508, Toronto ON M5T 1P5,