Scenario Analysis: This scenario presents a significant professional challenge due to the inherent uncertainty in advanced evidence synthesis and the potential for conflicting clinical pathways in perioperative medicine. Clinicians must navigate complex, often evolving, research landscapes to make critical decisions that directly impact patient safety and outcomes. The challenge lies in balancing the imperative to provide evidence-based care with the practical realities of individual patient variability, resource limitations, and the need for timely decision-making. This requires a robust framework for evaluating evidence and translating it into actionable clinical plans, adhering to established quality and safety standards. Correct Approach Analysis: The best professional approach involves a systematic and critical appraisal of the highest quality evidence available, prioritizing meta-analyses and randomized controlled trials, to inform the development of a patient-specific clinical decision pathway. This approach recognizes that while general guidelines are valuable, individual patient factors (comorbidities, functional status, patient preferences) must be integrated into the decision-making process. This aligns with the principles of evidence-based practice, which mandates the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. Regulatory frameworks and professional guidelines emphasize the importance of personalized care and the clinician’s responsibility to synthesize evidence with clinical judgment. Incorrect Approaches Analysis: Relying solely on the most recently published single study, regardless of its methodological rigor or the presence of contradictory evidence, represents a failure to engage in comprehensive evidence synthesis. This approach risks overemphasizing potentially biased or underpowered research, leading to suboptimal or even unsafe clinical decisions. It neglects the established hierarchy of evidence and the need for robust systematic reviews. Adopting a decision pathway based on anecdotal experience or the practices of a few respected colleagues, without a thorough review of the broader evidence base, is also professionally unacceptable. While experience is valuable, it must be informed by current, high-quality research. This approach risks perpetuating outdated practices or incorporating biases, failing to meet the standard of care expected in evidence-based perioperative medicine. Implementing a decision pathway based on the most readily available or easily accessible guidelines, without critically evaluating their applicability to the specific patient population or considering newer, more robust evidence, is another flawed approach. Guidelines are valuable starting points, but they are not static and require ongoing critical appraisal and adaptation in light of evolving research and individual patient needs. This can lead to a rigid application of recommendations that may not be optimal for all patients. Professional Reasoning: Professionals should employ a structured decision-making framework that begins with identifying the clinical question. This is followed by a comprehensive search for the best available evidence, critically appraising its quality and relevance. The evidence is then synthesized, considering its implications for different patient subgroups. Finally, this synthesized evidence is integrated with clinical expertise, patient values, and preferences to formulate a personalized and evidence-based clinical decision pathway. This iterative process ensures that decisions are grounded in robust evidence and tailored to individual patient circumstances, upholding the highest standards of quality and safety in perioperative medicine.

Scenario Analysis: This scenario is professionally challenging because determining eligibility for the Critical North American Perioperative Medicine Quality and Safety Review requires a nuanced understanding of both the stated purpose of the review and the specific criteria that define which institutions or programs are most likely to benefit from and contribute to its objectives. Misinterpreting these factors can lead to inefficient resource allocation, missed opportunities for improvement, and potentially a failure to address critical quality and safety gaps in perioperative care across North America. Careful judgment is required to balance broad accessibility with the focused intent of the review. Correct Approach Analysis: The best approach involves a comprehensive assessment that considers the institution’s demonstrated commitment to perioperative quality and safety initiatives, its current performance metrics in key perioperative areas, and its capacity to actively participate in and benefit from a collaborative review process. This approach is correct because it aligns directly with the stated purpose of such a review, which is to identify and disseminate best practices, address systemic issues, and drive measurable improvements in perioperative care. Regulatory and ethical justifications for this approach stem from the principle of maximizing the impact of quality improvement efforts. By focusing on institutions that are actively engaged and have data to contribute, the review can achieve its goals more effectively, leading to broader benefits for patient safety and care quality across the North American landscape. This also respects the resources involved in the review process by ensuring they are directed towards entities most likely to yield significant positive outcomes. Incorrect Approaches Analysis: One incorrect approach is to solely consider the size or volume of surgical procedures performed by an institution. While high volume may indicate experience, it does not inherently guarantee a commitment to quality or the presence of robust safety protocols. This approach fails ethically and regulatorily by potentially excluding smaller, highly dedicated institutions that may have innovative quality improvement programs or significant safety challenges that would benefit from review and collaboration. Another incorrect approach is to prioritize institutions based on their perceived prestige or reputation alone. This is ethically problematic as it can lead to bias and exclude deserving institutions that may not have the same level of public recognition but are actively working to improve perioperative care. Regulatorily, it deviates from the principle of evidence-based selection for quality improvement initiatives. Finally, an approach that focuses only on institutions that have recently experienced adverse events, without considering their proactive quality improvement efforts, is also flawed. While adverse events are critical indicators, a review’s purpose is often proactive and preventative, aiming to enhance systems before major failures occur. This approach misses the opportunity to engage institutions that are already demonstrating a strong commitment to quality and safety, potentially preventing future adverse events through shared learning and best practice implementation. Professional Reasoning: Professionals should employ a decision-making framework that begins with a clear understanding of the review’s overarching goals and intended outcomes. This involves defining specific, measurable criteria that reflect the review’s purpose. Next, gather relevant data and evidence from potential participants that speaks to these criteria, focusing on demonstrated commitment, performance data, and collaborative potential. Evaluate this information objectively, weighing the strengths and weaknesses of each potential participant against the established criteria. Finally, make a selection that maximizes the likelihood of achieving the review’s objectives and contributing to the advancement of perioperative quality and safety across North America, ensuring fairness and transparency in the process.

The assessment process reveals a complex clinical scenario involving a patient with a history of vague abdominal discomfort and a new onset of severe, localized pain. The challenge lies in navigating the diagnostic reasoning process efficiently and safely, selecting appropriate imaging, and interpreting the findings accurately to guide immediate perioperative management. This requires a systematic approach that prioritizes patient safety, adheres to established quality standards, and avoids unnecessary delays or inappropriate interventions. The best approach involves a structured diagnostic reasoning process that integrates clinical presentation with evidence-based imaging selection and interpretation. This begins with a thorough history and physical examination to generate a differential diagnosis. Based on this, the clinician selects the most appropriate imaging modality that offers the highest diagnostic yield for the suspected conditions, considering factors like radiation exposure, cost, and availability. Crucially, interpretation of imaging must be performed by a qualified radiologist or the ordering clinician if they possess the necessary expertise, with clear communication of findings and their implications for perioperative care. This aligns with principles of patient-centered care and evidence-based practice, aiming to minimize diagnostic errors and optimize treatment pathways, thereby upholding professional standards for quality and safety in perioperative medicine. An incorrect approach would be to proceed with empirical treatment without a clear diagnostic pathway, or to order a broad range of imaging studies without a focused differential diagnosis. This is professionally challenging because it can lead to delayed diagnosis, unnecessary radiation exposure, increased healthcare costs, and potential for iatrogenic harm. Ethically, it fails to uphold the principle of beneficence by not pursuing the most direct and effective diagnostic route. Another incorrect approach is to rely solely on the interpretation of a junior resident or a non-radiologist without adequate supervision or peer review, especially in complex or ambiguous cases. This is professionally unacceptable as it bypasses established quality control mechanisms designed to ensure accurate diagnosis. It poses a significant ethical risk by potentially leading to misinterpretation of critical findings, which could have dire consequences for patient management and outcomes. A further incorrect approach is to delay definitive imaging based on a low index of suspicion for a serious condition, or to proceed with surgery based on a presumptive diagnosis without adequate imaging confirmation when indicated. This is professionally hazardous as it increases the risk of intraoperative complications due to an unconfirmed or incorrect diagnosis. It violates the ethical duty of care by not taking all reasonable steps to ensure the patient is appropriately diagnosed and prepared for surgery. Professionals should employ a decision-making framework that emphasizes a systematic and iterative diagnostic process. This involves: 1) comprehensive clinical assessment to formulate a prioritized differential diagnosis; 2) evidence-based selection of diagnostic tests, considering the risks and benefits of each modality; 3) critical interpretation of test results, ideally in consultation with specialists; and 4) clear communication and integration of findings into the perioperative management plan. This framework ensures that diagnostic reasoning is robust, imaging selection is judicious, and interpretation is accurate, ultimately promoting patient safety and optimal outcomes.

Scenario Analysis: This scenario is professionally challenging because it requires balancing the need for continuous quality improvement and adherence to established performance standards with the potential impact of retake policies on individual practitioners’ careers and the overall team’s morale. Navigating these competing interests requires a nuanced understanding of the quality review framework and its ethical implications. Correct Approach Analysis: The best professional approach involves a transparent and consistent application of the established blueprint weighting and scoring criteria, coupled with a clearly communicated and fair retake policy. This approach prioritizes objective evaluation based on predefined standards, ensuring that all participants are assessed equitably. The regulatory and ethical justification lies in the principles of fairness, accountability, and continuous professional development. A well-defined blueprint ensures that the assessment accurately reflects the critical aspects of perioperative medicine quality and safety, and a clear retake policy provides a structured pathway for improvement without undue punitive measures, fostering a culture of learning and growth. Incorrect Approaches Analysis: One incorrect approach would be to arbitrarily adjust scoring or retake eligibility based on perceived effort or personal circumstances outside of the established criteria. This fails to uphold the integrity of the assessment process and can lead to perceptions of bias, undermining trust in the quality review system. It also deviates from the principle of objective evaluation mandated by quality assurance frameworks. Another incorrect approach is to implement a punitive retake policy that creates undue stress or discourages participation in future quality reviews. This can negatively impact team morale and create a climate of fear rather than a commitment to improvement. Ethically, it fails to support professional development and can be seen as counterproductive to the overarching goals of enhancing patient care. A third incorrect approach would be to overlook performance deficiencies that do not meet the blueprint standards, thereby avoiding the need for retakes. This directly contravenes the purpose of quality review, which is to identify and address areas for improvement. It represents a failure in professional responsibility to ensure the highest standards of perioperative medicine and could have serious implications for patient safety, violating ethical obligations to practice competently and diligently. Professional Reasoning: Professionals should approach quality review and retake policies by first thoroughly understanding the established blueprint, including weighting and scoring mechanisms. They should then consider the ethical implications of any policy, ensuring fairness, transparency, and a focus on professional development. Decision-making should be guided by the principle of upholding patient safety and quality of care, while also fostering a supportive environment for practitioners. When faced with ambiguity, consulting established guidelines and seeking consensus among peers or leadership is crucial.

Scenario Analysis: This scenario is professionally challenging because it requires a perioperative physician to balance the immediate need for comprehensive preparation with the practical constraints of a busy clinical schedule and the inherent variability in candidate learning styles and prior experience. Ensuring adequate preparation without overwhelming the candidate or compromising patient care demands careful resource allocation and personalized guidance. Correct Approach Analysis: The best professional approach involves a structured, yet flexible, timeline that prioritizes foundational knowledge and practical application, allowing for iterative feedback and adaptation based on the candidate’s progress. This approach aligns with the ethical imperative to ensure physician competence and patient safety, as mandated by professional bodies that emphasize continuous learning and skill development. It also reflects best practices in medical education, which advocate for learner-centered strategies that accommodate individual needs and learning paces. This method ensures that the candidate is not only exposed to the material but also has sufficient time to internalize, practice, and demonstrate mastery, thereby minimizing risks associated with underpreparation. Incorrect Approaches Analysis: One incorrect approach involves providing a generic, one-size-fits-all list of resources with an arbitrary deadline, without assessing the candidate’s baseline knowledge or learning style. This fails to acknowledge individual differences in learning and can lead to either insufficient preparation for some or unnecessary stress and time commitment for others. Ethically, this approach risks compromising patient safety by not adequately ensuring the candidate’s readiness. Another incorrect approach is to defer all preparation until immediately before the review, relying solely on last-minute cramming. This is highly risky as it does not allow for deep understanding or integration of complex perioperative concepts. It also disregards the principles of adult learning, which emphasize spaced repetition and reflective practice for effective knowledge retention and skill development. This method is ethically unsound as it prioritizes expediency over thoroughness, potentially endangering patients. A third incorrect approach is to overwhelm the candidate with an exhaustive list of every conceivable resource, leaving them to navigate and prioritize independently without clear guidance. While comprehensive, this can be paralyzing and inefficient, leading to wasted time and a lack of focus on critical areas. It fails to provide the structured support necessary for effective learning and can create anxiety, hindering the candidate’s ability to absorb and apply information effectively, thus posing a risk to quality and safety. Professional Reasoning: Professionals should employ a decision-making framework that begins with an assessment of the candidate’s current knowledge and experience. This should be followed by the collaborative development of a personalized preparation plan that includes a realistic timeline, prioritized resources, and regular checkpoints for feedback and adjustment. This iterative process ensures that preparation is both comprehensive and tailored, maximizing the likelihood of successful learning and ultimately, enhancing patient care quality and safety.

This scenario is professionally challenging because it requires balancing immediate patient needs with the long-term implications of a potentially undiagnosed underlying condition, all within the framework of established quality and safety protocols. The perioperative team must make rapid decisions under pressure, informed by both clinical presentation and a commitment to patient safety and continuous improvement. Careful judgment is required to avoid both overtreatment and undertreatment, and to ensure that diagnostic and therapeutic pathways are ethically sound and compliant with best practices. The best approach involves a systematic integration of foundational biomedical sciences with clinical medicine, prioritizing a comprehensive diagnostic workup that directly addresses the observed clinical anomaly. This means leveraging knowledge of physiology, pathology, and pharmacology to hypothesize potential causes for the patient’s symptoms and then designing investigations to confirm or refute these hypotheses. Specifically, this approach involves recognizing the potential for an underlying systemic issue that may manifest perioperatively, such as an undiagnosed endocrine disorder or a metabolic derangement, and initiating appropriate diagnostic tests to clarify the diagnosis before proceeding with definitive surgical management. This aligns with the ethical imperative to provide competent care and the quality and safety principle of accurate diagnosis as a foundation for effective treatment. It also reflects a commitment to understanding the patient’s complete health status, not just the immediate surgical problem. An incorrect approach would be to solely focus on the immediate surgical indication without further investigation into the patient’s systemic symptoms. This fails to acknowledge the potential for a serious underlying biomedical condition that could significantly impact perioperative outcomes and patient safety. It bypasses the crucial step of differential diagnosis informed by basic science principles, potentially leading to a delayed or missed diagnosis of a life-threatening condition. This approach risks patient harm by proceeding with surgery without a full understanding of the patient’s physiological state, violating the principle of beneficence and potentially leading to adverse events. Another incorrect approach would be to initiate broad, non-targeted investigations without a clear diagnostic hypothesis derived from the patient’s presentation and foundational biomedical knowledge. While thoroughness is important, a scattergun approach is inefficient, can lead to unnecessary patient burden and cost, and may obscure the true diagnosis by generating a large volume of potentially irrelevant data. This deviates from a scientifically grounded approach to diagnosis and quality improvement, which emphasizes targeted investigation based on informed clinical reasoning. A final incorrect approach would be to defer all diagnostic responsibility to a specialist consultation without actively participating in the diagnostic process or considering the implications for the perioperative plan. While specialist input is valuable, the perioperative team has a direct responsibility for the patient’s immediate safety and well-being. Failing to engage with the diagnostic process means missing opportunities to integrate biomedical science knowledge with clinical decision-making and potentially delaying critical perioperative management decisions. The professional decision-making process for similar situations should involve a structured approach: first, thoroughly assess the patient’s presentation, integrating observed clinical signs and symptoms with foundational biomedical knowledge to generate a list of differential diagnoses. Second, prioritize these diagnoses based on their potential severity and impact on perioperative management. Third, design targeted investigations to systematically rule in or rule out the most critical diagnoses. Fourth, consult with specialists as needed, but maintain active involvement in the diagnostic and treatment planning process. Finally, ensure all decisions are documented and communicated effectively within the perioperative team, always prioritizing patient safety and quality of care.

Scenario Analysis: This scenario is professionally challenging because it involves a conflict between a physician’s perceived clinical judgment and established institutional protocols designed to ensure patient safety and quality of care. The physician’s desire to proceed with a procedure based on their experience, without adhering to a required peer review, creates a direct tension with the institution’s commitment to a standardized, evidence-based approach to quality assurance. Navigating this requires balancing professional autonomy with the collective responsibility for patient safety and adherence to regulatory expectations for quality improvement. Correct Approach Analysis: The best professional practice involves the physician engaging with the peer review process as mandated by the institution. This approach acknowledges that while individual expertise is valuable, a structured, multidisciplinary review is essential for identifying potential risks, ensuring adherence to best practices, and upholding the institution’s commitment to quality and safety standards. This aligns with the principles of continuous quality improvement and patient safety mandated by regulatory bodies and professional organizations that emphasize collaborative decision-making and adherence to established protocols for high-risk procedures. Incorrect Approaches Analysis: Proceeding with the procedure without completing the peer review, despite the protocol, represents a failure to adhere to institutional quality assurance mechanisms. This bypasses a critical safety check designed to protect patients and could be seen as a disregard for established guidelines, potentially violating professional ethical obligations to prioritize patient well-being through adherence to recognized safety standards. Escalating the disagreement to a higher administrative authority without first attempting to resolve it through the established peer review channels undermines the intended function of the peer review committee. This approach can be seen as circumventing the established process for quality assessment and could lead to a breakdown in collegial communication and problem-solving within the medical staff. Refusing to participate in the peer review process altogether, citing personal experience, demonstrates a lack of commitment to the institution’s quality improvement framework and potentially to the broader professional responsibility of contributing to collective patient safety. This stance disregards the established mechanisms for ensuring that all practitioners meet a consistent standard of care, which is a fundamental expectation in regulated healthcare environments. Professional Reasoning: Professionals should approach such situations by first understanding the rationale behind the established protocol. If a protocol seems to impede necessary care, the professional response is to engage with the process, provide evidence and arguments within that framework, and seek to understand the concerns of the reviewers. If disagreements persist, a structured escalation process within the institution, respecting the established channels, is the appropriate next step. The overarching principle is to prioritize patient safety and quality of care through adherence to, and constructive engagement with, established quality assurance and peer review systems.

Scenario Analysis: This scenario is professionally challenging because it requires balancing the immediate need for patient care with the imperative to maintain the integrity and safety of the perioperative environment. The introduction of a novel device, even with perceived benefits, necessitates a structured evaluation process to prevent potential harm to patients, staff, or the institution. The pressure to adopt new technologies can be significant, but it must be tempered by rigorous quality and safety protocols. Correct Approach Analysis: The best professional practice involves a systematic, evidence-based evaluation of the new device within the existing quality and safety framework. This approach prioritizes patient safety by ensuring the device has undergone thorough vetting, including review by relevant committees (e.g., Value Analysis, Patient Safety Committee), assessment of its impact on workflow, staff training, and potential risks. This aligns with the core principles of perioperative quality and safety, which emphasize a proactive, risk-averse approach to the adoption of new technologies and practices. Regulatory bodies and professional organizations consistently advocate for such structured evaluation processes to uphold standards of care and patient well-being. Incorrect Approaches Analysis: One incorrect approach involves immediate adoption of the device based solely on the surgeon’s enthusiasm and perceived efficiency gains. This bypasses essential safety checks and regulatory oversight, potentially exposing patients to unknown risks and violating institutional policies designed to protect patient safety. It fails to consider the broader implications for the entire perioperative team and the established quality metrics. Another incorrect approach is to defer the decision entirely to the surgeon without any institutional review. This undermines the collective responsibility for patient safety and quality within the perioperative setting. It neglects the multidisciplinary nature of perioperative care and the need for consensus on the adoption of new technologies that affect multiple stakeholders and patient outcomes. A third incorrect approach is to dismiss the device outright without a formal evaluation process, simply due to its novelty or the perceived inconvenience of a review. This stifles innovation and may prevent the adoption of beneficial technologies that could improve patient care. It represents a failure to engage with the quality improvement process and a missed opportunity to enhance perioperative safety and efficiency through evidence-based adoption. Professional Reasoning: Professionals should employ a decision-making framework that prioritizes patient safety and adheres to established quality improvement processes. This involves: 1) Recognizing the need for a structured evaluation of any new technology or practice. 2) Engaging relevant stakeholders and committees for comprehensive risk assessment and benefit analysis. 3) Relying on evidence and established protocols rather than anecdotal claims or individual preferences. 4) Documenting the evaluation process and decision-making rationale. 5) Ensuring adequate training and competency validation before implementation.

Scenario Analysis: This scenario presents a professional challenge due to the inherent tension between rapid information dissemination for quality improvement and the need for rigorous, validated data to inform critical perioperative decisions. The pressure to act quickly on emerging trends must be balanced against the risk of implementing changes based on incomplete or misleading information, which could compromise patient safety. Careful judgment is required to ensure that quality improvement initiatives are both timely and evidence-based, adhering to established professional standards and regulatory expectations for patient care. Correct Approach Analysis: The best professional practice involves a systematic approach to quality and safety review that prioritizes data validation and consensus-building before widespread implementation of changes. This approach, which involves forming a multidisciplinary committee to review preliminary findings, conduct further targeted data collection if necessary, and develop evidence-based recommendations, aligns with the principles of robust quality improvement frameworks. Such frameworks, often guided by professional society recommendations and regulatory expectations for patient safety, emphasize the importance of a structured, data-driven process. This ensures that any proposed changes are well-supported, understood by all stakeholders, and likely to achieve the desired safety outcomes without introducing unintended risks. The process fosters a culture of continuous learning and improvement grounded in reliable evidence. Incorrect Approaches Analysis: One incorrect approach involves immediately disseminating preliminary, unvalidated data to all perioperative staff with a directive to alter practice. This fails to meet professional standards for evidence-based practice and can lead to confusion, resistance, and the implementation of potentially ineffective or harmful interventions. It bypasses the critical step of peer review and validation, which is essential for ensuring the reliability of quality improvement data. Another unacceptable approach is to dismiss the preliminary findings entirely due to their preliminary nature, without any further investigation or discussion. This represents a failure to engage with potential quality and safety issues and can lead to missed opportunities for improvement. It neglects the ethical imperative to proactively address patient safety concerns and can be seen as a dereliction of professional responsibility to contribute to a culture of safety. A further flawed approach is to rely solely on anecdotal evidence or the opinions of a few senior practitioners to guide immediate practice changes. While experience is valuable, quality improvement requires objective, quantifiable data. Relying on subjective interpretations without empirical support risks perpetuating biases or addressing perceived problems that do not reflect the actual data, thereby failing to achieve meaningful improvements in patient safety and potentially misallocating resources. Professional Reasoning: Professionals should adopt a decision-making framework that begins with acknowledging the importance of both speed and accuracy in quality and safety initiatives. When presented with preliminary data, the first step should be to assess its potential significance and the need for further investigation. This involves engaging relevant stakeholders, forming a multidisciplinary team to review the data, and establishing a clear process for validation and consensus. The framework should prioritize evidence-based decision-making, ethical considerations for patient well-being, and adherence to established professional guidelines and regulatory requirements for quality improvement and patient safety. This structured approach ensures that actions taken are informed, justifiable, and contribute positively to the perioperative environment.

This scenario is professionally challenging because it requires balancing the patient’s autonomy and right to information with the clinician’s expertise and the need for timely, effective care in a perioperative setting. The inherent vulnerability of patients undergoing surgery, coupled with potential cognitive impairment or anxiety, necessitates a sensitive and structured approach to shared decision-making. Careful judgment is required to ensure that the patient’s values and preferences are understood and incorporated without compromising safety or leading to undue delay. The approach that represents best professional practice involves a structured, iterative conversation that begins with assessing the patient’s understanding and readiness to engage, followed by presenting information about treatment options in a clear, understandable manner, and then actively eliciting their values and preferences before collaboratively developing a plan. This aligns with the ethical principles of autonomy and beneficence, and is supported by guidelines from professional bodies emphasizing patient-centered care. Specifically, this approach respects the patient’s right to self-determination by ensuring they are fully informed and have the opportunity to express their wishes. It also promotes beneficence by ensuring the chosen course of action is aligned with what the patient deems most important, thereby enhancing their overall experience and potentially improving outcomes. An incorrect approach that involves the clinician making a unilateral decision based on their interpretation of what is “best” for the patient, without adequate exploration of the patient’s values or preferences, fails to uphold the principle of patient autonomy. This can lead to care that is misaligned with the patient’s life goals or deeply held beliefs, causing distress and potentially undermining trust in the healthcare system. Another incorrect approach, which involves overwhelming the patient with excessive, highly technical medical jargon without checking for comprehension or providing opportunities for questions, is ethically problematic. This can lead to a superficial understanding or complete misunderstanding of the situation, rendering the “shared” decision-making process illusory and violating the principle of informed consent. The patient cannot truly share in the decision if they do not comprehend the information presented. A further incorrect approach, where the clinician presents only one option as the “obvious” or “only” choice, thereby subtly coercing the patient’s agreement, also fails ethically. This approach undermines the spirit of shared decision-making by limiting the patient’s perceived choices and can lead to resentment or regret if the outcome is not as desired, as their genuine preferences were not explored or respected. Professionals should employ a decision-making framework that prioritizes patient engagement. This involves: 1) establishing rapport and assessing the patient’s current understanding and emotional state; 2) providing information in a patient-friendly format, using teach-back methods to confirm comprehension; 3) exploring the patient’s values, goals, and concerns related to the perioperative period and beyond; 4) collaboratively weighing the benefits, risks, and uncertainties of each viable option in light of the patient’s values; and 5) documenting the shared decision and the rationale behind it.