Values-based practice in surgical care means clinicians having the skills to engage in dialogue about values with their patients in shared decision-making based on the available evidence-based options
This page gives an example from surgical practice (‘To operate or not to operate’), describes one clinician’s approach to implementation (‘What would you do doctor?’), and introduces our template for values-based training (‘A starting point for other clinical areas?’)
An example from surgical practice: To operate or not to operate?
Dialogue about values in shared decision-making is illustrated by Mrs Jones’ story (see box). This is based on a real clinical encounter but with biographical details changed
Most people with painful arthritic knees want to get rid of the pain. It was natural therefore that the surgeon should assume this was what mattered to Mrs Jones. No doubt it did matter. But what mattered more to her was to recover the mobility she needed to do her gardening.
It was thus Mrs Jones’ individual values (what mattered most to her) that determined her shared decision with the surgeon to opt for conservative treatment
Eighteen months later Mrs Jones still had a painful knee but with anti-inflammatory medication and physiotherapy she had recovered sufficient mobility to start gardening again
A Win-Win Situation
Understanding Mrs Jones’ individual values, ie what really mattered to her, was thus a ‘win’ for everyone
- Mrs Jones’ got back to her gardening
- The surgeon and his team saved a precious resource of time
- The NHS avoided several thousand pounds of wasted operating and related costs
Shared decision-making where it works well is thus both cost- and time-effective. This is why it has been increasingly emphasised in recent healthcare guidance
For further clinical examples please go to How is Values-based Practice in Surgical Care Implemented? and follow the link to Resources Library
For examples of healthcare guidance on shared values-based decision making, including clinical guidelines, codes of practice and legal decisions
Read more: Why Values-based Practice in Surgical Care is Important
Implementation: ‘What would you do, doctor?’
In Mrs Jones’ story her values came to light as a result of a chance remark. The surgeon had the skills to pick this up and explore its implications with Mrs Jones. But how do we make this kind of shared decision-making routine without it becoming a meaningless tick-box exercise?
This is one of the areas where there is no one right answer. The context of practice as well as our skills and orientation as individual practitioners make this a matter for individual choice. But we can share learning and experience of ‘what works’
Ashok Handa, a consultant vascular surgeon, describes his own approach to values-based shared decision-making in the context of a busy outpatient clinic
Vascular surgery commonly involves decisions about major operations for potentially life threatening conditions. Faced with such decisions patients naturally ask Ashok Handa what he would do. He after all is the expert. But before replying he finds out what matters to the individual concerned across a range of issues (time in hospital, risk of relapse, etc) that bear on the evidence-based options available. With this additional brief (five minute) exchange he is able to say ‘what he would do’ but from the perspective of his patient’s values rather than his own
Again, every situation is different. Like other clinical skills we can learn from others and improve with practice. But there is no ‘one size fits all’ in values-based practice
A template for values-based training: A starting point for other clinical areas?
We have created a template based on our experience in surgery that aims to support the development of values-based practice in other areas of clinical care.
For more on the training template including exemplar learning materials please go to How is Values-based Practice in Surgical Care Implemented? and follow the links to A Training Template and Resources Library