Using CollaboRATE to Characterize Surgeon-Level Shared Decision-Making Performance

BACKGROUND: Shared decision-making (SDM) aligns treatment recommendations with patient values and has been shown to positively affect surgical outcomes. We aimed to characterize the variation in levels of SDM among surgeons using CollaboRATE, a validated patient-reported tool for assessing SDM in clinical care. STUDY DESIGN: This multicenter retrospective cohort study analyzed American College of Surgeons NSQIP patient-reported outcome data from 30,957 surgical patients treated by 2,921 surgeons across 65 hospitals between 2020 and 2023. Patient-reported scores were analyzed to (1) characterize the distribution of patient scores; (2) explore the distribution of surgeon-level performance; and (3) identify patient, surgeon, and hospital-level factors associated with higher and lower performance. Multilevel logistic regression, adjusted for clustering at the hospital level, assessed factors associated with surgeon-level performance. RESULTS: Of patient responses, 64% reported adequate SDM (a composite score of 27). No single CollaboRATE domain disproportionately accounted for inadequate patient ratings. Among 977 surgeons, only 1.2% achieved mean scores of 27, whereas 80.6% of surgeons achieved a median score of 27. Multivariable analysis revealed that lower surgeon performance associated with male sex (odds ratio [OR] 2.75, 95% CI 2.34 to 3.23), cardiothoracic specialty (OR 5.78 [4.41 to 7.57], rural setting (OR 5.55 [1.19 to 25.82]), and greater than 31 years of practice (OR 2.29 [2.02 to 2.59]). CONCLUSIONS: Using CollaboRATE to describe surgeon-level variability will be useful for both benchmarking and targeted quality improvement. These results suggest SDM might be a modifiable skill warranting targeted improvement efforts and surgeon-specific training.