Clinical analysis of preoperative and postoperative anxiety and depression in patients with proximal humeral fractures.

Shared decision making (SDM) is a collaborative process in which patients and healthcare providers (HCPs) share the best available evidence and discuss patients’ informed preferences when making healthcare decisions []. SDM has several components, including presenting treatment options, sharing information about the advantages and disadvantages of each option, identifying patient preferences based on tailored information, and making decisions that reflect these preferences [, ]. These major processes can be classified into three parts: inviting patients to participate in decision making (team talk), sharing information, and discussing preferences regarding available options (option talk), and reaching a decision (decision talk). These parts influence each other and form a continuous cycle from deliberation to active listening []. Therefore, understanding the applications of SDM requires focusing on the decision making process, rather than simply determining whether SDM occurred. SDM has increasingly been used in various clinical contexts across the continuum of care, from diagnosis to management. After diagnosis, the treatment process is particularly important because it involves complex factors, including the quality of life, costs, and preferences regarding potential side effects. Previous studies have identified specific clinical situations and demonstrated the positive impact of SDM. In emergency situations, patients often prefer physicians’ determinations over engaging in SDM, with decisions frequently driven by the surgeon’s expertise []. By contrast, SDM has been more widely implemented in patients with chronic conditions such as cancer, or those requiring complex treatment regimens [–]. These findings suggest that incorporating patient preferences and considering various treatment options over long-term care are essential, and that SDM may enhance treatment satisfaction and clinical outcomes in this population. Patients with liver disease, particularly those with cirrhosis or liver cancer, require long-term management. These patients may also experience various complications such as hepatic encephalopathy, esophageal variceal bleeding, or hepatorenal syndrome []. Although many chronic diseases follow relatively predictable clinical courses, liver disease can involve acute clinical changes and temporary cognitive changes associated with these complications. These changes can affect patients’ ability to participate in decision making at different time points. Consequently, in liver disease management, the SDM process may be more dynamic than in other conditions and may require more deliberation and frequent re-evaluation. As such, a circular and recursive SDM model is adequate to analyze the decision making process of patients with liver disease. This model does not describe the process as a linear progression but as a “team–option–decision” cycle, thus allowing for immediate and iterative adjustments required by clinical changes in liver disease.