Chapter 4 Psychological Effects in Surgical Decision-making: Evidence, Ethics and Outcomes
Y. Gavriel Ansara
Numerous psychological effects can influence decision-making in diverse areas of surgical practice, such as general, gynaecological, cardiothoracic, and urological surgery. Evidence suggests that conscientious surgeons may underestimate the extent to which they, potential surgical candidates and their loved ones, and colleagues in multi-disciplinary teams are influenced by cognitive, environmental, and societal influences. For example, the framing effect is one form of cognitive effect in which varying the description and presentation of information can influence surgical decision-making. Research shows that subtle changes to the way that information is presented can even lead people to change their surgical preferences and to give or withdraw consent. This finding raises a number of clinical, ethical, and legal concerns about how surgeons present information. This chapter will introduce a range of concepts used by researchers to categorise and study psychological effects in medical decision-making, with particular focus on surgical decisions. This chapter will discuss the relevance of these psychological effects to surgical practice; explore cases that illustrate how surgeons’ awareness of these effects can improve professional practice and clinical outcomes; and suggest specific steps that surgeons and other health professionals can take to integrate an awareness of these psychological effects into their professional interactions.