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Comment & Response
February 13, 2019

Cost and Outcomes Information Should Be Part of Shared Decision Making—Reply

Author Affiliations
  • 1Department of Surgery, University of Wisconsin–Madison
  • 2Department of Medical History and Bioethics, University of Wisconsin–Madison
  • 3Department of Surgery, Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada
  • 4Department of Surgery, Stanford University, Stanford, California
JAMA Surg. 2019;154(5):466. doi:10.1001/jamasurg.2018.5599

In Reply We appreciate the comments from Weeks and Weinstein regarding our article.1 We agree with Weeks and Weinstein that information about mortality and out-of-pocket costs matter to patients who are considering surgical intervention. Like other types of information, eg, risks or alternative treatments, we worry that simple disclosure of data is not enough to make a shared decision. Policies designed ostensibly to promote shared decision making that instead target types of information for disclosure encourage a buyer-beware attitude for patients, with little regard for the clinical skill required to present choices, elicit preferences, and ensure the treatment plan is aligned with the patient’s goals and values. After all, decisions around out-of-pocket costs and location of surgery have tradeoffs. Some patients may prefer a small increase in mortality to have care closer to home, while others might prefer to receive care from a specific surgeon or institution despite large out-of-pocket costs. To support shared decision making, the surgeon’s job is not to simply disclose information but instead to assist patients as they navigate this unfamiliar territory.

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