Skip to main content

Time for a paradigm shift in shared decision-making in trauma and emergency surgery? Results from an international survey

Abstract

Background

Shared decision-making (SDM) between clinicians and patients is one of the pillars of the modern patient-centric philosophy of care. This study aims to explore SDM in the discipline of trauma and emergency surgery, investigating its interpretation as well as the barriers and facilitators for its implementation among surgeons.

Methods

Grounding on the literature on the topics of the understanding, barriers, and facilitators of SDM in trauma and emergency surgery, a survey was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was sent to all 917 WSES members, advertised through the society’s website, and shared on the society’s Twitter profile.

Results

A total of 650 trauma and emergency surgeons from 71 countries in five continents participated in the initiative. Less than half of the surgeons understood SDM, and 30% still saw the value in exclusively engaging multidisciplinary provider teams without involving the patient. Several barriers to effectively partnering with the patient in the decision-making process were identified, such as the lack of time and the need to concentrate on making medical teams work smoothly.

Discussion

Our investigation underlines how only a minority of trauma and emergency surgeons understand SDM, and perhaps, the value of SDM is not fully accepted in trauma and emergency situations. The inclusion of SDM practices in clinical guidelines may represent the most feasible and advocated solutions.

Background

Trauma and emergency surgery teams include a group of specialists (comprising surgeons, emergency physicians, anesthesiologists, and nurses, among others) cooperating to provide patients with high-quality care. Such professionals operate under challenging circumstances, high stress, and time pressures. They often have little awareness of the trauma’s causes, the patients’ identities, current conditions, and care preferences [1]. While team dynamics appear fundamental to ensuring the best quality of care from a patient-centric perspective, knowledge translation and sharing processes [2, 3] are essential to patient-centered care and the inviolable patient-physician relationship [4]. Indeed, the clinical team might lack time to examine the various possibilities and treatment options with the patients, including prognostic information [5, 6].

The value of shared decision-making (SDM) in patient-centered care is well recognized in the context of contemporary healthcare. Healthcare professionals and patients are encouraged to engage in SDM to jointly make decisions, considering the best available evidence and the patients’ values and treatment choices. SDM is anticipated to improve patient treatment compliance and, consequently, health outcomes. In particular, SDM is the most advantageous choice for judgments that must consider the patient’s preferences and wishes. When two or more comparable treatment options are available, healthcare professionals should support the patient in selecting his or her best option, depending on how each patient rates the benefits and hazards of each choice [7]. Therefore, SDM stands as a pillar of patients’ autonomy, and clinicians have the moral and ethical duty to support patients in making decisions that embrace their values and priorities [8]. Still, engaging in effective SDM practices is not a surgical care panacea. Barriers may emerge due to a gap in the clinical knowledge between the patient and the physician, the feelings and concerns that the patient may have, the complexity of interactions among diagnoses and treatments, and the lack of time or training to conduct a fruitful discussion with the patient and the family or caregivers. This means that both clinicians and patients should find effective ways and tools to translate and share knowledge, despite their differences in terms of backgrounds, medical mastery, concerns, and doubts [3, 9]. The recent clinical literature has highlighted the relevance of adequate facilitators to support such a practice [2, 10], including the role of non-technical skills in improving communication [5, 11, 12].

Recent experiences and studies in trauma and emergency settings have underlined how the implementation and measurement of SDM are complex [8]. Indeed, sometimes the patient’s life may be in danger, leaving little time to make a clinical decision. Still, other times, conditions may allow physicians hours or more before the treatment begins, giving patients time to learn about the potential alternatives and make an informed decision about the next medical steps. The surgical literature [13] has stressed the benefits of applying SDM in trauma and emergency surgery, including better clinical outcomes by enhancing the quality of patient’s recovery [14], better managing the patient’s expectations [15], and limiting surgical interventions when they are not necessary [16]. Benefits can also be gathered from the hospital’s organization, as SDM provides better patient management and flow [17], stimulating patient-centric care [18] and leading to patient empowerment and co-production practices [19, 20]. All in all, when SDM is employed in trauma and emergency settings, patients and their families enjoy a better hospital experience [21] while physicians comply with ethics and moral norms [22]. Training and counseling appear as the most common facilitators for the effective implementation of SDM in trauma and emergency settings [21, 23]. Time and resource limitations make it difficult for the in-charge physician to have a fruitful conversation with the patient. When the patient load is heavy, there is little opportunity to spend time with a single patient who needs to understand and decide from a range of clinical alternatives.

Starting from these premises and research gaps, the paper aims to deepen the barriers, facilitators, and dynamics of SDM in trauma and emergency settings, by employing a multi-national survey endorsed by the World Society of Emergency Surgery (WSES).

Methods

Design and setting

Our exploratory study of the international trauma and emergency surgeons’ community used a population-based online questionnaire to gather demographic, knowledge, and practice-based information regarding their SDM understanding and dynamics. The online questionnaire was conducted in English through Google Forms [4, 6], and followed the Checklist for Reporting Results of Internet E-Surveys (CHERRIES), as reported in Appendix 1 [24].

A steering committee within the WSES was created, involving a multidisciplinary panel of practitioners and scholars in the fields of trauma and emergency surgery, healthcare management, innovation, and organization science. No Institutional Review Board (IRB) approval was needed, as non-interventional studies do not necessarily require approval by an ethics committee. The survey participants were exclusively clinicians who decided to participate voluntarily. No significant identifying information about the participants is possible. The study was conducted following the principles of the Declaration of Helsinki.

Starting from a review of the literature, a research protocol was conceived and shared by the principal investigators (LC and FDM) with the steering committee. The leading references to create the protocol and the survey structure were gathered from Woltz et al. [8], Mathijssen et al. [7], Cobianchi et al. [4], and Dal Mas et al. [2]. Before the initiative’s official launch, the research protocol and the online survey were reviewed by the steering committee and filled in by a sample of surgeons to avoid mistakes.

The survey was launched at the end of November 2021 and remained open until mid-August 2022. An e-mail invitation to participate in the initiative was sent out within the WSES newsletter to all 917 WSES members and disseminated through the society’s website and Twitter profile. Moreover, an e-mail invitation was sent out to the mailing list of the Team Dynamics Study Group [4, 6]. Four reminders followed through the same channels. Although WSES membership was not a prerequisite for enrollment, we expect that most of the participants come from the 917 WSES members to whom the research initiative was advertised, obtaining, therefore, a response rate close to 70%.

The invitation e-mail comprised detailed information about the initiative’s rationale and aims, the expected duration (approximately 10 min), and the opportunity of signing up in the Team Dynamics Study Group to continue investigating and sharing the findings. The participants’ identities were kept anonymous. The research protocol and the investigators’ names were kept confidential as well.

Survey

The first group of questions aimed at understanding the participants’ characteristics. The same questions were gathered from the previous Team Dynamics investigation [4, 6], and they included gender, the number of years of experience in trauma/emergency surgery, the kind of institution (academic vs non-academic), the country, the position held, the eventual participation within a trauma team (institutionalized or not, and of which kind), the type of trauma leader, the educational courses attended, and the presence of diverse team members.

The second group of questions aspired to understand trauma and emergency surgeons’ perception and knowledge of SDM by employing a yes/no question and an open question, following Woltz et al. [8].

The third group of questions wanted to investigate the frequency and perception of SDM starting from a list of items gathered from Woltz et al. [8] and Mathijssen et al. [7] to be rated on a 5-point Likert scale.

The fourth and last group of questions aimed at exploring the barriers and facilitators to SDM, to be rated on a 5-point Likert scale. More specifically, barriers were gathered from the study of Mathijssen et al. [7], while facilitators were inspired from the original list of 32 items mentioned by Dal Mas et al. [2], which were later grouped into nine categories, as also reported by other investigations [4].

The survey’s questions related to SDM are reported in Appendix 2.

Statistical analysis

Descriptive statistical analysis was conducted using the software R [25].

Manual coding was also employed concerning the qualitative questions. Concerning the understanding of SDM, participants were then asked to provide a definition of SDM through an open question. Results were manually coded by two researchers (LC and FDM), who rated each statement as concordant, discordant, or inconclusive, following the analysis of Woltz et al. [8] and Cobianchi et al. [4]. The same methodology was applied concerning the situations or conditions where SDM could be used. Two researchers (LC and FDM) coded all the statements to group them into meaningful categories.

Results

Participants

The questionnaire was filled in by 650 surgeons. Participants came from 71 countries on the five continents. Still, the sample was not equally distributed, with most surgeons coming from Europe (477, 73%) and especially Italy (251, 39%). The ten countries with the highest number of participants globally accounted for 465 respondents (72%).

The sample was made up of 118 female surgeons (18%), 531 males (82%), and one participant preferring not to disclose their gender. Surgeons had a range of 1–35 years of experience in the field, with a mean of 12. Most participants came from academic institutions (499, 77% of the sample), with 540 of them officially part of an emergency surgery team (83%). The roles declared varied, with the majority of surgeons being senior consultants (233, 36%). One hundred and fourteen (18%) were departmental heads.

Table 1 reports the descriptive statistics about the participants and institutions involved in the study, while Table 2 highlights some statistics about the number of respondents according to their locations.

Table 1 Descriptive statistics about surgeons and institutions participating in the investigation
Table 2 Number of respondents according to their location

Understanding of SDM

Regarding the understanding of the concept of SDM, surgeons were first asked if they were familiar with the term. Four hundred and eighty-four of them (74%) replied they were, and the remaining 166 (26%) declared they were not. As specified, each given statement was rated as concordant, discordant, or inconclusive.

To be rated as concordant, definitions needed to stress the concept of surgeons (or multidisciplinary trauma or emergency team) involving the patient in the clinical decisions. Interestingly, less than half of the participants (290, 45% of the sample) provided definitions that could be rated as concordant according to the abovementioned criterion. 93 participants (14% of the sample) gave responses that were incomplete, showing only a partial view of the phenomenon, being so rated as inconclusive. The remaining 267 surgeons (41%) gave answers that were not fitting the general definition of SDM. Interestingly, while some participants declared that they did not know what SDM meant, or did not provide any concrete answers (73, equal to 11%), most (194, 30% of the sample) stressed the multidisciplinary aspect of emergency care and the need to decide within the clinical team, not even mentioning the possibility to include the patient in the picture.

Table 3 reports some examples of answers that were rated as concordant, inconclusive, and discordant [4, 8].

Table 3 Examples and ways of rating the given answers to the question: What is your understanding of SDM?

Engaging in SDM

Surgeons were asked to rate 15 items gathered from the studies of Woltz et al. [8] and Mathijssen et al. [7] using a 5-point Likert scale where 1 meant “not important” and 5 “very important.”

Although all 15 items got a mean evaluation of over 3.78, some of them got a major agreement. Findings reveal a significant relationship between an SDM mindset and a patient-centric view. In particular, surgeons recognized the value of informing the patient about the pros and cons of the chosen treatment plan (mean 4.62, with a standard deviation of 0.67), and explaining the chance of those favorable or adverse outcomes happening. Decision-making seems a very relevant concept to trauma and emergency surgeons, as they recognized the importance of sharing the fact that a decision has to be made.

Among the less rated items, we underline the need to spend time investigating the patient’s preferences (mean 3.78, with a standard deviation of 1). Interestingly, there was one more similar item in the list, reported as “Understanding the patient’s references,” which got a higher evaluation (mean 4.21, with a standard deviation of 0.89). The less rated item was about asking the patient to bring someone (maybe a family member or caregiver) to the consultation (mean 3.78, with a standard deviation of 1.03).

Table 4 reports the results related to the relevant items to SDM.

Table 4 Relevant items to SDM

The survey also included a list of potential barriers that could make it challenging for surgeons to engage in SDM practices. Those items were gathered from the investigation of Mathijssen et al. [7], to be rated using a 5-point Likert scale where 1 meant “not important” and 5 “very important.”

The participants stressed that in emergency contexts, decisions often need to be taken in within a very short period of time (mean 4.11, standard deviation 0.88). They also claimed that emergency and trauma teams collaborate successfully (mean 3.83, standard deviation 0.94). Surgeons denied that SDM practices might be in contrast with clinical guidelines (mean 2.16, standard deviation 1.2). Therefore, that would not represent a barrier to its practical application.

Full results and ratings are reported in Table 5.

Table 5 Barriers to SDM

Situations or diagnoses in trauma and emergency surgery suitable for SDM

Through an open question, participants were asked to name any situation and/or clinical condition in which SDM practices may be successfully applied. As anticipated, statements were coded and grouped into meaningful categories.

Part of the sample named some situations. For instance, 84 participants claimed that any situation may be suitable for SDM practices if the patient or a substitute (namely, a family member or caregiver) is available to discuss with the physician. 82 surgeons named some trauma situations, with the patient still able to interact with the clinical team. 20 participants were not able to provide examples. Interesting enough, 11 of them claimed that no situation in trauma or emergency contexts would be suitable for SDM practices.

The other part of the sample preferred to name some specific conditions or diagnoses. Among the most rated, we can recall appendicitis/diverticular disease (116), acute abdomen (54), non-urgent oncological issues (37), acute cholecystitis (36), and bowel obstruction (31).

The full list of items is reported in Table 6.

Table 6 Situations/diagnoses suitable for SDM

Facilitators

Surgeons were asked about the facilitators that could support SDM practices. Those which recorded the highest importance were training (mean 4.3/5), time to engage patients (mean 4.19/5), clinical guidelines and cases (mean 4.18/5), and cultural competence (mean 4.17/5). The less rated item was that of electronic medical records (mean 3.74/5). Results are reported in Table 7.

Table 7 Facilitators to SDM

Discussion

SDM represents one of the pillars of the modern healthcare scenario [26]. Scholars, policymakers, and healthcare institutions advocate the right of the patient to actively participate in clinical decisions, along with the physicians or medical team in charge. The advantages of SDM are numerous [13], and they recall better satisfaction and hospital experience for the patient [14], and better alignment with the chosen treatment [19, 20].

While in some medical specialities, like oncology, SDM is widely applied [27, 28], previous studies have underlined difficulties in engaging in SDM practices in emergency and trauma contexts [8]. Suppose some of such barriers refer to the fact that sometimes patients’ lives are in danger, or the patient is unconscious and maybe his/her identity is unknown. Still, there may be some emergency and trauma situations in which SDM can be applied, as there may be hours or more time available before the treatment begins.

Our investigation, endorsed by the WSES, had to aim to deepen the dynamics, understanding, barriers, and facilitators of SDM practices, enquiring trauma, and emergency surgeons. Results are in line with the previous literature [8], and some interesting findings emerge.

While most of the surgeons declared that they were familiar with the term “SDM,” open responses about its meaning depict a completely different image. Indeed, only 45% of the participants were able to provide a definition that matched the concept of the patient being involved in the clinical decisions. More than 11% of our participants had no idea about what SDM entailed, and the 30% of them had a completely different (and wrong) meaning in mind. Hundreds of surgeons saw SDM as the clinical trauma or emergency team members co-deciding and discussing the treatment options for the patient. The word “multidisciplinary” was named several times to stress the effort to join forces by enquiring colleagues with different backgrounds or expertise. Still, the process was seen as “doctors-only.” Interestingly, several surgeons name the need to find a solution “in the best patient’s interests” to underline how much physicians care about the best possible outcome for their patients. Still, it seems like it is neither doable nor useful to engage the patient and the family in the decision-making process. Clinical teams know how to do their job, and together they can reach the best clinical decision according to the situation. All the efforts are, indeed, dedicated to adequate knowledge translation and communication processes within the team, involving also non-technical skills like leadership [1, 4].

Similar results can also be gathered when deepening the topics of engaging in SDM processes in terms of practices and barriers. Surgeons generally recognize the importance of informing the patient about a specific treatment option’s advantages and hazards and aligning (whenever possible) the treatment to the patient’s values and wishes. However, surgeons seem less available to “investigate” such preferences when they are not transparent or maybe when a communication effort is required to engage with the patient. Barriers are defined mainly in the lack of time that often characterizes trauma and emergency contexts. Still, when enquired about possible situations or conditions when SDM might be successfully applied, surgeons did provide several examples. Among the facilitators to support such practices, participants named training but also clinical guidelines, while surgeons seem to have less trust in technological devices and online tools.

Our investigation underlined how trauma and emergency surgeons seem more concentrated on making things work within their teams rather than engaging in dialogues with their patients, with a lack of an in-depth understanding of the benefits of such a practice. Such results are not surprising, not only as emergency and trauma situations often need to be managed within minutes, but also when we consider the debate going on in such a specific surgical speciality. Indeed, team dynamics are deemed crucial to reaching the best clinical outcomes, and much effort (also from scientific societies like the WSES) has been concentrated on topics like communication, non-technical skills, etc. It seems like surgeons see the best value in making their teams work smoothly than looking at what is happening outside.

As said, the literature has underlined how engaging in SDM practices requires adequate tools and facilitators, as the competencies and emotional gap between the patient and the physician may be broad [29]. Still, a patient-centric philosophy of care cannot leave such topics behind, even when it comes to challenging situations like those connected to trauma or emergencies. While surgeons strongly believe in training, they also rely on clinical guidelines, which should encompass such principles and values even when reporting tough clinical situations or conditions. In this perspective, the role of scientific societies like the WSES is again crucial to take the lead in stimulating a paradigm shift, in which team dynamics are essential, but so are the relationships with the patients. In such a view, other team members may support surgeons in successfully dealing with such dynamics, for example, nurses, who usually spend more time with patients and their families [30,31,32,33].

Last but not least, an open issue arises about using technologies to support SDM practices. Do such technological tools represent minor or weak support for SDM, or is there a problem connected to the digital culture among healthcare professionals? The fact that such an item records the highest standard deviation (1.11) highlights a significant divergence in opinions. Therefore, such an issue deserves further investigation in future studies.

Limitations

Although our sample is numerous, with 650 participants, it is not equally distributed. Indeed, most participants work in Europe and, more specifically, in Italy. The specific situation of the Italian and European contexts (including the features of National Healthcare Systems) may have biased some of our results. Moreover, most participants are men and belong to academic institutions. Again, such situations may have impacted some views or responses. Our limitations, along with the perceived interest of the international community on the topic of SDM, may stimulate new in-depth studies and investigations on such a relevant and up-to-date theme.

Conclusion

In concluding our work, we should begin from the premise that inspired it. SDM represents a crucial and “hot” topic in today’s healthcare atmosphere, involving all medical specialities. Emergency and trauma contexts often represent challenging situations in which SDM may look difficult to apply. Surprisingly, only less than half of the inquired surgeons are familiar with the term and meaning of SDM. The 30% of the participants of our study wrongly identify SDM as multidisciplinary decision-making among medical team’s members, not seeing the value of involving the patient in the process. Modern patient-centered ethics sees a call for all medical professionals to find ways to engage patients in clinical decisions whenever possible. Such a call involves emergency and trauma surgeons as well.

Our results suggest the need for scientific societies like the WSES, undergraduate and postgraduate educational institutions, and healthcare managers and policymakers to stimulate an SDM culture, also through training courses and formalized guidelines. Therefore, our findings may be relevant to support practical actions.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Abbreviations

SDM:

Shared decision-making

WSES:

World Society of Emergency Surgery

CHERRIES:

Checklist for Reporting Results of Internet E-Surveys

IRB:

Institutional Review Board

ER:

Emergency Room

OR:

Operating Room

References

  1. Cobianchi L, Dal Mas F, Massaro M, Fugazzola P, Catena F, Ansaloni L. Knowledge Management and dynamics as perceived by emergency surgery teams: a quantitative study. In: Garcia-Perez A, Simkin L, editors. Proceedings of the 22nd European Conference on Knowledge Management - ECKM2021. Coventry, UK, 2–3 September 2021: Academic Conferences & Publishing International Ltd. 2021. p. 217–24.

  2. Dal Mas F, Garcia-Perez A, Sousa MJ, Lopes da Costa R, Cobianchi L. Knowledge translation in the healthcare sector. A structured literature review. Electron J Knowl Manag. 2020;18(3):198–211.

    Article  Google Scholar 

  3. Graham ID, Logan J, Harrison MB, Straus SE, Tetroe J, Caswell W, et al. Lost in knowledge translation: time for a map? J Contin Educ Health Prof. 2006;26(1):13–24.

    Article  PubMed  Google Scholar 

  4. Cobianchi L, Dal Mas F, Massaro M, Fugazzola P, Coccolini F, Kluger Y, et al. Team dynamics in emergency surgery teams: results from a first international survey. World J Emerg Surg. 2021;16:47.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Stahel PF, Cobianchi L, Dal Mas F, Paterson-Brown S, Sakakushev BE, Nguyen C, et al. The role of teamwork and non-technical skills for improving emergency surgical outcomes: an international perspective. Patient Saf Surg. 2022;16(1):1–10. https://doi.org/10.1186/s13037-022-00317-w.

    Article  Google Scholar 

  6. Cobianchi L, Dal Mas F, Massaro M, Biffl W, Catena F, Coccolini F, et al. Diversity and ethics in trauma and acute care surgery teams: results from an international survey. World J Emerg Surg. 2022;17(1):44. https://doi.org/10.1186/s13017-022-00446-8.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Mathijssen EGE, Van Den Bemt BJF, Wielsma S, Van Den Hoogen FHJ, Vriezekolk JE. Exploring healthcare professionals’ knowledge, attitudes and experiences of shared decision making in rheumatology. RMD Open. 2020;6(1):1–9.

    Article  Google Scholar 

  8. Woltz S, Krijnen P, Pieterse AH, Schipper IB. Surgeons’ perspective on shared decision making in trauma surgery. A national survey. Patient Educ Couns. 2018;101(10):1748–52. https://doi.org/10.1016/j.pec.2018.06.002.

    Article  PubMed  Google Scholar 

  9. Lemire N, Souffez K, Laurendeau MC. Facilitating a knowledge translation process. Knowledge review and facilitation tool. Quebec: Institut Publique de Santé du Quebec; 2013.

    Google Scholar 

  10. Gibbon S. Family medicine, ‘La Herencia’ and breast cancer; understanding the (dis)continuities of predictive genetics in Cuba. Soc Sci Med. 2011;72:1784–92.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Lepeley MT. Soft skills: the language of human centered management. In: Lepeley MT, Beutell N, Abarca N, Majluf N, editors. Soft skills for human centered management and global sustainability. London: Routledge; 2021.

    Google Scholar 

  12. Dal Mas F, Bagarotto EM, Cobianchi L. Soft Skills effects on Knowledge Translation in healthcare. Evidence from the field. In: Lepeley MT, Beutell N, Abarca N, Majluf N, editors. Soft skills for human centered management and global sustainability. New York: Routledge; 2021. p. 95–109.

    Google Scholar 

  13. Dal Mas F, Massaro M, Woltz S, Ruta F, Catena F, Fugazzola P, et al. Shared decision-making in trauma and emergency surgery settings. A literature review. In: Cerchione R, Centobelli P, editors. Proceedings of the 23rd European Conference on Knowledge Management - ECKM. Naples: Academic Conferences & Publishing International Ltd.; 2022. p. 278–88.

  14. Tighe P, Buckenmaier CC, Boezaart AP, Carr DB, Clark LL, Herring AA, et al. Acute pain medicine in the United States: a status report. Pain Med (United States). 2015;16(9):1806–26.

    Article  Google Scholar 

  15. Thunnissen FM, Drager LD, Braak B, Drenth JPH, Van Laarhoven CJHM, Schers HJ, et al. Healthcare utilisation of patients with cholecystolithiasis in primary care: a multipractice comparative analysis. BMJ Open. 2021;11(11):1–8.

    Article  Google Scholar 

  16. Parmar AD, Coutin MD, Vargas GM, Tamirisa NP, Sheffield KM, Riall TS. Cost-effectiveness of elective laparoscopic cholecystectomy versus observation in older patients presenting with mild biliary disease. J Gastrointest Surg. 2014;18(9):1616–22.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Heiss KF, Raval MV. Patient engagement to enhance recovery for children undergoing surgery. Semin Pediatr Surg. 2018;27(2):86–91. https://doi.org/10.1053/j.sempedsurg.2018.02.005.

    Article  PubMed  Google Scholar 

  18. Brown TT, Hurley VB, Rodriguez HP. Association of patient engagement strategies with utilisation and spending for musculoskeletal problems in the USA: a cross-sectional analysis of Medicare patients and physician practices. BMJ Open. 2021;11(11): e053121.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Janssen SJ, Teunis T, Guitton TG, Ring D, Spoor AB, Chauhan A, et al. Do surgeons treat their patients like they would treat themselves? Clin Orthop Relat Res. 2015;473(11):3564–72.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Cobianchi L, Dal Mas F, Massaro M, Bednarova R, Biancuzzi H, Filisetti C, et al. Hand in hand: a multistakeholder approach for Co-production of surgical care. Am J Surg. 2022;223(1):214–5.

    Article  PubMed  Google Scholar 

  21. Newcomb AB, Allred C, Grove C, Newcomb H, Mohess D, Griffen MM, et al. Surgeon communication and family understanding of patient prognosis in critically ill surgical patients: a qualitative investigation informs resident training. J Surg Educ. 2019;76(6):e77-91. https://doi.org/10.1016/j.jsurg.2019.05.017.

    Article  PubMed  Google Scholar 

  22. Abbasgholizadeh Rahimi S, Rodriguez C, Croteau J, Sadeghpour A, Navali AM, Légaré F. Continuing professional education of Iranian healthcare professionals in shared decision-making: lessons learned. BMC Health Serv Res. 2021;21(1):1–9.

    Article  Google Scholar 

  23. Madani A, Gips A, Razek T, Deckelbaum DL, Mulder DS, Grushka JR. Defining and measuring decision-making for the management of trauma patients. J Surg Educ. 2018;75(2):358–69. https://doi.org/10.1016/j.jsurg.2017.07.012.

    Article  PubMed  Google Scholar 

  24. Eysenbach G. Improving the quality of web surveys: the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). J Med Internet Res. 2004;6(3):1–6.

    Article  Google Scholar 

  25. R Development Core Team. The R Manuals [Internet]. R. 2021 [cited 2021 Mar 12]. Available from: https://cran.r-project.org/manuals.html

  26. Osei-Frimpong K, Wilson A, Lemke F. Patient co-creation activities in healthcare service delivery at the micro level: the influence of online access to healthcare information. Technol Forecast Soc Change. 2018;126:14–27.

    Article  Google Scholar 

  27. Lee JK, Keam B, An AR, Kim TM, Lee SH, Kim DW, et al. Surrogate decision-making in Korean patients with advanced cancer: a longitudinal study. Support Care Cancer. 2013;21(1):183–90.

    Article  PubMed  Google Scholar 

  28. Biancuzzi H, Dal Mas F, Miceli L, Bednarova R. Post breast cancer coaching path: a co-production experience for women. In: Paoloni P, Lombardi R, editors. Gender Studies, Entrepreneurship and Human Capital IPAZIA 2019 Springer Proceedings in Business and Economics. Cham: Springer; 2020. p. 11–23.

    Google Scholar 

  29. Brunoro-Kadash C, Kadash N. Time to care: A patient-centered quality improvement strategy. Leadersh Heal Serv. 2013;26(3):220–31.

    Article  Google Scholar 

  30. Ruta F, Ferrara P, Terzoni S, Dal Mas F, Bottazzi A, Prendi E, et al. The attitude towards organ donation: Differences between students of medicine and nursing. A preliminary study at Unizkm - Catholic University “Our Lady of Good Counsel” of Tirana. Nurse Educ Today. 2021;105208. https://doi.org/10.1016/j.nedt.2021.105208.

  31. Featherstone RM, Leggett C, Knisley L, Jabbour M, Klassen TP, Scott SD, et al. Creation of an integrated knowledge translation process to improve pediatric emergency care in Canada. Health Commun [Internet]. 2018;33(8):980–7. https://doi.org/10.1080/10410236.2017.1323538.

    Article  PubMed  Google Scholar 

  32. Dal Mas F, Biancuzzi H, Massaro M, Miceli L. Adopting a knowledge translation approach in healthcare co-production. A case study. Manag Decis. 2020;58(9):1841–62.

    Article  Google Scholar 

  33. Dal Mas F, Biancuzzi H, Massaro M, Barcellini A, Cobianchi L, Miceli L. Knowledge translation in oncology. A case study. Electron J Knowl Manag. 2020;18(3):212–23.

    Google Scholar 

Download references

Acknowledgements

Please see the list of the Team Dynamics Study Group members. Recayi Aapoaylu, Sakarya University Training and Research Hospital General surgery Sakarya, Turkey. Kenneth Lyle Abbott, Department of Surgery, University of Florida Gainesville, United States. Abubaker Abdelmalik, General Surgery Dept., Misrata Medical Center, Misrata, Libya. Nebyou Seyoum Abebe, Department of surgery college of health sciences, Addis Ababa University, Addis Ababa, Ethiopia. Fikri Abu-Zidan, Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates. Yousif Abdallah Yousif Adam, Tullamore, Ireland. Harissou, Adamou, Department of Surgery, Université de Zinder Faculté des sciences de la Santé, Hãpital National de Zinder, Zinder, Niger. Dmitry Mikhailovich Adamovich, Department of Surgical Diseases II, Senior Lecturer at Gomel State Medical University, Gomel, Belarus. Ferdinando Agresta, Dept. of General Surgery, AULSS2 Trevigiana del Veneto, Vittorio Veneto (TV), Italy. Antonino Agrusa, Department of Surgical, Oncological and Oral Sciences—University of Palermo, Palermo, Italy. Emrah Akin, Sakarya University Faculty of Medicine, Sakarya, Turkey. Mario Alessiani, Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia—Department of Surgery, ASST Pavia, Pavia, Italy. Henrique Alexandrino, Faculty of Medicine, University of Coimbra, Coimbra, Portugal. Syed Muhammad Ali, Acute Care Surgery, Hamad Medical Corporation, Doha, Qatar. Department of Acute Care Surgery, Hamad Medical Corporation, Doha, Qatar. Vasilescu, Alin Mihai, Grigore T Popa University of Medicine and Pharmacy, Iasi Romania, First Surgical Clinic, St Spiridon University Hospital, Iasi, Romania. Pedro Miguel Almeida, Centro Hospitalar e Universitario do Algarve—Hospital de Portimao, Portimão, Portugal. Mohammed Mohammed Al-Shehari, Sana’a University—College of Medicine, Sana’a, Yemen. Michele Altomare, Sapienza University of Rome, Rome, Italy. Francesco Amico, Dept. of Trauma at John Hunter Hospital, School of Medicine and Public Health at University of Newcastle, Newcastle NSW, Australia. Michele Ammendola, Health of Science Department, “Magna Graecia” University Medical School, Digestive Surgery Unit, “Mater Domini” Hospital, Catanzaro, Italy. Jacopo Andreuccetti, General Surgery 2, ASST Spedali Civili of Brescia, Brescia, Italy. Elissavet Anestiadou, 4th Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece. Alfredo Annicchiarico, Universitã di Parma, Italy. Amedeo Antonelli, Universitã degli studi di Roma Tor Vergata, Rome, Italy. Daniel Aparicio-Sanchez, Emergency Surgery Unit (Virgen del Rocío Hospital), Sevilla, Spain. Antonella Ardito, Departmento of General Surgery Asst-fbf-sacco, Milan, Italy. Giulio Argenio, UOC Chirurgia Generale ed Oncologica, AO San Pio, Benevento, Italy. Catherine Claude Arvieux, Grenoble-Alpes University Hospital, Grenoble, France. Catherine Arvieux, CHU et Université Grenobles Alpes, Grenoble, France. Ingolf Harald Askevold, Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Giessen, Germany. Boyko Tchavdarov Atanasov, Umhat Eurohospital, Medical University Plovdiv, Plovdiv, Bulgaria. Goran Augustin, University Hospital Centre Zagreb, Zagreb, Croatia. Selmy Sabry Awad, Department of General surgery-Mansoura Faculty of Medicine, Mansoura, Egypt. Giulia Bacchiocchi, Department of Surgical Science, University of Rome Tor Vergata, Rome, Italy. Carlo Bagnoli, Department of Management, Ca’ Foscari University of Venice, Venice, Italy. Hany Bahouth, Trauma center, Rambam medical center, Haifa, Israel, Israel. Efstratia Baili, UGI Surgery- Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom. Lovenish Bains, Department of Surgery, Maulana Azad Medical College, New Delhi, India, India. Gian Luca Baiocchi, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy. Miklosh Bala, Department of General Surgery, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel, Jerusalem, Israel. Carmen Balagué, Digestive Surgery. Hospital Universitari Mutua Terrassa, Terrassa, Spain. Dimitrios, Balalis, Surgery, Saint Savvas Cancer Hospital, Halandri—Athens, Greece. Edoardo, Baldini, Unitã Operativa Complessa di Chirurgia—Ospedale Santa Maria delle Stelle, Melzo (Milano), Italy. oussama, Baraket, Département of general surgery. Bizerte hospital .faculty of Médecine of Tunis University Tunis El Manar, Bizerte, Tunisia. Suman, Baral, Department of Surgery, Dirghayu Pokhara Hospital, Pokhara, Nepal. Mirko, Barone, Department of General and Thoracic Surgery, "SS. Annunziata" University Hospital of Chieti, Chieti, Italy. Alberto Gonzãlez Barranquero, General and Digestive Surgery Department, Ramãn y Cajal University Hospital, Madrid, Spain. Jorge Arturo Barreras, Secretaria de Salud, Hermosillo, Mexico. Gary Alan Bass, Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, United States. Zulfu Bayhan, Sakarya University, Faculty of Medicine, Department of General Surgery, Sakarya, Turkey. Giovanni Bellanova, UOC Chirurgia Generale PO D. Camberlingo Francavilla Fontana, Francavilla Fontana (BR), Italy. Offir Ben-Ishay, Department of General Surgery, Rambam health Care Campus, Haifa Israel. Fabrizio Bert, University of Turin, Turin, Italy. Valentina Bianchi, Chirurgia d’Urgenza e del Trauma, Fondazione Policlinico Gemelli IRCCS, Roma, Italy. Helena Biancuzzi, Ipazia Observatory on Gender Research, Rome, Italy. Raluca Bievel Radulescu, Banca degli occhi, Mestre, Italy. Mark Brian Bignell, Surgical Emergency Unit, Oxford University NHS Trust, Oxford, United Kingdom. Alan Biloslavo, General Surgery Department, Cattinara University Hospital. ASUGI, Trieste, Trieste, Italy. Roberto Bini, Emergency Department Niguarda Hospital, Milano, Italy. Daniele Bissacco, Vascular Surgery Department IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan, Italy. Paoll Boati, Asst Santi Paolo Carlo Milano, Milano, Italy. Guillaume Boddaert, Thoracic and Vascular surgery Department—Percy Military Hospital, Clamart, France. Branko Bogdanic, School of Medicine University of Zagreb, Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia. Cristina Bombardini, University Hospital of Ferrara, Surgical Department, Colorectal Unit, Ferrara, Italy. Luigi Bonavina, University of Milan, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, Division of General Surgery, Milano (Italy), Italy. Luca Bonomo, Department of General Surgery University Hospitals Dorset, Poole, United Kingdom. Andrea Bottari, Digestive Surgery Unit, AOU Careggi, Firenze, Italy. Konstantinos Bouliaris, General Surgery Department, Koutlimbaneio & Triantafylleio General Hospital of Larissa, Larissa, Greece. Gioia Brachini, Dept of Surgery P. Valdoni—sapienza University, Rome, Italy. Antonio Brillantino, Department of Surgery, “A. Cardarelli” Hospital, Naples, Italy, Napoli, Italy. Giuseppe Brisinda, Department of Surgery, Fondazione Policlinico Universitario A Gemelli, IRCCS, Roma, Italy. Maloni Mamada Bulanauca, Labasa Hospital Fiji, Labasa, Fiji. Luis Antonio Buonomo, Hopital “Dr. Alberto Balestrini.” University of Buenos Aires, Buenos Aires, Argentina. Jakob Burcharth, Department of Gastrointestinal and Hepatic Diseases, Copenhagen University Hospitals Herlev and Gentofte; Emergency Surgery Research Group Copenhagen (EMERGE), Herlev, Denmark. Salvatore Buscemi, Department of Surgical, Oncological and Oral Science, Policlinico “P.Giaccone” Palermo, Italy. Francesca, Calabretto, University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy; Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy. Giacomo Calini, University of Udine, Udine, Italy. Valentin Calu, Elias Emergency University Hospital, Department of Surgery, Bucharest, Romania. Fabio Cesare Campanile, Ospedale San Giovanni Decollato—Andosilla, Civita Castellana, Italy. Riccardo Campo Dall’Orto, Vascular Surgery, University of Padua, Padua, Italy. Andrea Campos-Serra, Department of Surgery, Parc Tauli University Hospital, Sabadell, Spain. Joao Miguel Carvas, Servicao de Cirurgia Geral, Hospital de Bragansa, Bragança, Portugal. Marco, Cascella, IRCCS Pascale, Naples, Italy. Gianmaria Casoni Pattacini, Chirurgia Generale, d’urgenza e Nuove Tecnologie, Ospedale Civile di Baggiovara, Modena, Italy. Valerio, Celentano, Chelsea and Westminster Hospital, London, United Kingdom. Danilo, Corrado, Centonze, Unitã operativa complessa chirurgia generale ospedale Umberto I di Enna, Enna, Italy. Marco Ceresoli, General and Emergency Surgery, Milano-Bicocca University, School of Medicine and Surgery, Monza, Italy. Dimitrios Chatzipetris, Department of Surgery, Metaxa Cancer Hospital, Piraeus, Greece. Antonella, Chessa, Chirurgia Generale uslsudesttoscana, Orbetello Grosseto, Italy. Maria Michela, Chiarello, Asp Cosenza, Cosenza, Italy. Mircea, Chirica, service de chirurgie digestive, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France. Serge, Chooklin, Department of Surgery, Lviv Regional Clinical Hospital, Lviv, Ukraine. Christos, Chouliaras, Athens Medical Center, Athens, Greece. Sharfuddin, Chowdhury, Trauma Center, King Saud Medical City, Riyadh, Saudi Arabia. Pasquale, Cianci, University of Foggia-ASL BAT, Andria, Italy. Nicola, Cillara, UOC Chirurgia Generale ASL8 Cagliari, Cagliari, Italy. Stefania Cimbanassi, Acute Care Surgery and Trauma-ASST GOM Niguarda, Milano, Italy. Stefano, Piero Bernardo, Cioffi, General Surgery Trauma Team ASST GOM NIGUARDA MILAN, ITALY, Milano, Italy. Enrique, Colãis-Ruiz, General Surgery. Hospital Universitario Son Llatzer, Palma de Mallorca, Spain. Elif, Colak, University of Samsun, Samsun Training and Research Hospital, Department of General Surgery, Samsun, Turkey. Luigi Conti, Department of Surgery, Acute care surgery Unit, G. Da Saliceto hospital, Piacenza, Italy. Alessandro, Coppola, General Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, General Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Italy. Tiago, Correia de Sa, General Surgery Department, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal. Silvia, Dantas, Costa, General Surgery, CHVNG/E,EPE, V.N. Gaia, Portugal. Valerio, Cozza, Chirurgia d’urgenza e del trauma, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy. Giuseppe, Curro’, Health Science Department, Magna Graecia University of Catanzaro, Catanzaro, Italy. Kirsten, Felicia Ann-Sophie Aimee, Dabekaussen, Department of Surgery, Spaarne Gasthuis, Haarlem, Netherlands. Fabrizio, D’ACAPITO, General and Oncologic Surgery, Morgagni—Pierantoni Hospital, AUSL Romagna, Forlì, Italy. Dimitrios, Damaskos, Department of General Surgery, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom. Giancarlo, D’Ambrosio, Department of General Surgery. University Sapienza, Rome, Italy. Koray, Das, University of Health Science Adana City Training and Research Hospital. General Surgery, Adana, Turkey. Richard, Justin, Davies, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom. Andrew, Charles, de Beaux, Royal Infirmary of Edinburgh, Department of General Surgery and Motol University Hospital, 3rd department of Surgery, Edinburgh, United Kingdom. Sara Patricia, De Lebrusant Fernandez, General and Digestive Surgery. Hospital Universitario de Jerez de la Frontera, Sevilla, Spain. Alessandro, De Luca, General Surgery Unit, Molfetta Hospital, Molfetta, Italy. Belinda, De Simone, Department of emergency, digestive And metabolic minimally invasive surgery, Poissy And Saint Germain en Laye Hospitals, Poissy, France, Poissy, France. Francesca, De Stefano, General surgery I, San Matteo Hospital, University of Pavia, Pavia, Italy. Luca, Degrate, San Gerardo Hospital, Monza, Italy. Zaza, Demetrashvili, Surgery Department, Tbilisi State Medical University, Georgia . Andreas, Kyriacou, Demetriades, Department of Neurosurgery, Royal Infirmary Edinburgh, Edinburgh, United Kingdom. Dzemail, Smail, Detanac, Department of general surgery, General hospital Novi Pazar, Novi Pazar, Serbia and Montenegro. Agnese, Dezi, Department of Emergency and Organ Transplantation (DETO), University of Bari, Italy, Bari, Italy. Giuseppe, Di Buono, Department of surgical, oncological and orale sciences—university of Palermo, Palermo, Italy. Isidoro Di Carlo, University of Catania, Catania, Italy. Pierpaolo Di Lascio, AOR San Carlo—Potenza—UOC Chirurgia Generale e Urgenza, Potenza, Italy. Marcello Di Martino, AORN Cardarelli, Italia (IT), Italy. Salomone, Di Saverio, Dept of General Surgery, San benedetto del tronto Hospital, AV5, ASUR marche, San benedetto del tronto, Italy. Bogdan Diaconescu, Carol Davila University of Medicine and Pharmacy Bucharest, Emergency Hospital of Bucharest Romania, Bucharest, Romania. Jose J. Diaz, R Adams Cowley Shock Trauma, University of Maryland Medical Center, Baltimore, United States. Rigers Dibra, Department of Emergency and Organ Transplant (DETO), University “Aldo Moro” Medical School of Bari, Bari, Italy. Evgeni Nikolaev Dimitrov, Department of Surgical Diseases, University Hospital “Prof. Dr. Stoyan Kirkovich,” Stara Zagora, Bulgaria. Vincenza, Paola, Dinuzzi, Operative Unit of General Surgery Magenta Hospital, Milan, Italy, Magenta, Italy. Sandra, Dios-Barbeito, University Hospital Virgen del Rocio, Seville, Spain. Jehangir Farman Ali, Diyani, Sindh Institute of Urology and Transplant, Karachi, Pakistan. Agron Dogjani, Department of Surgery, University of Medicine, Tirana, Albania. Maurizio, Domanin, Department of logo Clinical Sciences and Community Health, University of Milan, Italy. Mario, D’Oria, Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Italy, Trieste, Italy. Virginia, Duran Munoz-Cruzado, Department of General Surgery, Virgen del Rocao University Hospital, Seville, Spain. Barbora, East, 3rd Department of Surgery, 1st Medical Faculty of Charles University, Motol University Hospital, Prague, Czech Republic. Mikael, Ekelund, Department of Surgery, Skane University Hospital, Lund & Malmö, Sweden. Gerald Takem Ekwen, Surgery Lead. PIH Liberia, Harper, Liberia. Adel Hamed Elbaih, Associate Professor of Emergency Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt. Muhammed Elhadi, Tripoli University Hospital, Tripoli, Libya. Natalie Enninghorst, University of Newcastle, Department of Traumatology John Hunter Hospital, Newcastle, Australia. Mairam Ernisova, Department of Hospital Surgery with the Course of Operative Surgery of KSMA named after I.K. Akhunbaeva, Bishkek, Kyrgyzstan. Juan Pablo, Escalera-Antezana, Emergency/Surgery department—Hospital Viedma, Cochabamba, Bolivia. Sofia Esposito, General, Emergency Surgery and New Technologies, Baggiovara General Hospital, Modena, Italy. Giuseppe Esposito, ARNAS Brotzu, Cagliari, Italy. Mercedes Estaire-Gãmez, Hospital Universitario Severo Ochoa Leganés, Madrid, Spain. Camilla Nikita Farã, Universitã degli studi di Pavia, Pavia, Italy. Roser Farre, General Surgeon. Fundacia Althaia, Manresa, Spain. Francesco Favi, UOC Chirurgia Generale e d’Urgenza Ospedale M. Bufalini Cesena AUSL della Romagna, Cesena, Italy. Luca Ferrario, General Surgery and Trauma Team, ASST Niguarda, Milan, Italy. Antonjacopo Ferrario di Tor Vajana, Swiss Surgical Practice, Lugano, Switzerland. Claudia Filisetti, Pediatric Surgery Department, Vittore Buzzi Children’s Hospital of Milan, Milan, Italy. Francesco Fleres, Department of Human Pathology of the Adult and Evolutive Age “Gaetano Barresi,” General and Emergency Surgery Unit, University of Messina, Messina 98125, Italy, Messina, Italy. Vinicius Cordeiro Fonseca, Acute Care Surgery Service of Hospital Vivalle, São José dos Campos, Brazil. Alexander Forero-Torres, General Surgery. La Paz University Hospital, Madrid, Spain. Francesco Forfori, Università di Pisa, Pisa, Italy. Laura Fortuna, AOU Careggi, Firenze, Italy. Evangelos Fradelos, General Surgery Department, Saint Savvas Anticancer Hospital of Athens, Athens, Greece. Gustavo, P., Fraga, Division of Trauma Surgery, University of Campinas, Campinas, Brazil. Pietro, Fransvea, Chirurgia d’urgenza e del trauma. Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. Simone, Frassini, General Surgery I Unit, Fondazione IRCCS Policlinico San Matteo, Universita di Pavia, Pavia, Italy. Giuseppe, Frazzetta, Chirurgia oncologica ARNAS civico Palermo, Palermo, Italy. Isabella, Frigerio, HPB Unit, Pederzoli Hospital, 37019 Peschiera del Garda, Italy. Maximos, Frountzas, First Propaedeutic Department of Surgery, Medical School of Athens, National and Kapodistrian University of Athens, Hippocration General Hospital of Athens, Athens, Greece. Mahir, Gachabayov, Department of Abdominal Surgery, Vladimir City Emergency Hospital, Vladimir, Russia. Rita, Galeiras, Critical Care Unit, A Coruña, Spain. Belen, MatÃas, GarcÃa, General Surgery of Princpe de Asturias Teaching, Alcalá de Henares, Spain. Alain, A., Garcia Vazquez, IHU Strasbourg, Strasbourg, France. Simone, Gargarella, Department of Medical Science, Oral and Biotechnology of University of Chieti-Pescara “G.D’Annunzio,” Chieti, Italy. Ibrahim Umar, Garzali, Department of Surgery, Aminu Kano Teaching Hospital, Nigeria., Kano, Nigeria. Wagih, Mommtaz, Ghannam, Mansoura faculty of medicine, Mansoura, Egypt. Faiz Najmuddin, Ghazi, Department of Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia, Kota Bharu, Malaysia. Lawrence, Marshall, Gillman, Department of surgery university of Manitoba, Winnipeg, Canada. Rossella, Gioco, Department of General Surgery Policlinico G.Rodolico, Catania, Italy. Alessio, Giordano, Department of Surgery, General Surgery Unit, S.Stefano Hospital, Prato, Italy. Luca, Giordano, Department Valdoni; “La Sapienza” University of Rome, Roma, Italy. Carlo, Giove, Università degli studi di Bari, Bari, Italy. Giorgio, Giraudo, Department of Surgery, AO Santa Croce e Carle, Cuneo, Italy. Mario, Giuffrida, General Surgery Unit-Parma University Hospital, Parma, Italy. Michela, Giulii Capponi, UOC Chirurgia Generale e d’Urgenza, Ospedale Santo Spirito in Sassia, Roma, Italy. Emanuel, Gois Jr., Department of Surgery, State University of Londrina, Londrina, Brazil. Carlos, Augusto, Gomes, Universidade Federal de Juiz de Fora, Minas Gerais, Juiz de Fora, Brazil. Felipe, Couto, Gomes, Surgery Unit, Faculdade Ciências Médicas e da Saúde de Juiz de Fora (SUPREMA), MG, Brazil. Ricardo Alessandro, Teixeira, Gonsaga, Centro Universitario Padre Albino, Catanduva—SP, Brazil. Emre, Gonullu, Sakarya university training and research hospital, Sakarya, Turkey. Jacques, Goosen, Department of Surgery, University of Witwatersrand, Johannesburg, South Africa. Tatjana, Goranovic, University Department of Anaesthesiology, Resuscitation and Intensive Care Medicine, Sveti Duh University Hospital, Zagreb, Croatia. Raquel, Gracia-Roman, General surgery, Hospital Universitari Parc Tauli, Sabadell, Spain. Giorgio, Maria Paolo, Graziano, Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche, Università degli studi di Pavia, Pavia, Italy. Ewen, Alexander, Griffiths, Department of Upper GI Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom. Tommaso, Guagni, Emergency surgery department, Careggi University Hospital, Florence, Italy. Dimitar, Bozhidarov, Hadzhiev, UMHAT “St. George”- First Clinic of Surgery, MU-Plovdiv- Prop. of Surgical Diseases, Plovdiv, Bulgaria. Muad, Gamil, Haidar, AlGamhoria teaching hospital and AlNaqib hospital, Aden, Yemen. Hytham, K. S., Hamid, Department of Surgery, Kuwaiti Specialized Hospital, Khartoum, Sudan. Timothy, Craig, Hardcastle, Dept of Surgery, Nelson R Mandela School of Clinical Medicine, UKZN and Inkosi Albert Luthuli Central Hospital, Trauma and Burns Service, Durban, South Africa. Firdaus, Hayati, Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia, Kota Kinabalu, Malaysia. Andrew, James, Healey, General Surgery, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom. Andreas, Hecker, Dept. of General & Thoracic Surgery, University Hospital of Giessen, Giessen, Germany. Matthias, Hecker, University Hospital Giessen, Germany. Edgar, Fernando, Hernandez Garcia, Cirugia de trauma, Hospital Central militar, Ciudad de México, Mexico. adrien, Montcho, hodonou, général surgery, CHUD, Université of Parakou, Parakou, Benin. eduardo, cancio, huaman, Hospital Almenara—Lima, Lima, Peru. Martin, Huerta, General and Digestive Surgery Unit, Hospital Universitari Vall d’Hebron, Barcelona, Spain, Barcelona, Spain. AINI, FAHRIZA, IBRAHIM, DEPARTMENT OF SURGERY, UNIVERSITI MALAYSIA SARAWAK, KUCHING, Malaysia. Basil, Mohamed Salabeldin, Ibrahim, Manchester Foundation Trust, Manchester, United Kingdom. Giuseppe, Ietto, University of Insubria, Varese, Italy. Marco, Inama, General Surgery Department—Pederzoli Hospital, Peschiera del Garda, Italy. Orestis, Ioannidis, 4th Department of Surgery, Medical School, Aristotle University of Thessaloniki, General Hospital “George Papanikolaou,” Thessaloniki, Greece, Thessaloniki, Greece. Arda, Isik, General Surgery, Istanbul Medeniyet University, Istanbul, Turkey. Nizar, Ismail, Trauma and Orthopaedics Department, Royal Cornwall Hospital, Truro, United Kingdom. Azzain, Mahadi Hamid, Ismail, Queen Elizabeth Hospital-Birmingham, Department of Trauma&Orthopaedics, Birmingham, United Kingdom. RUHI, FADZLYANA, JAILANI, Surgical Unit, Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Nilai, Negeri Sembilan, Malaysia. Ji Young, Jang, Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea, South. Christos, Kalfountzos, General Hospital of Larissa “Koutlimpaneio and Triantafylleio,” Larissa, Greece. Sujala, Niatarika Rajsain, Kalipershad, Department of Surgery, Tameside General Hospital, Manchester, United Kingdom. Emmanouil, Kaouras, Department of Surgery, Metaxa Cancer Hospital, Piraeus, Greece. Lewis, Jay, Kaplan, University of Pennsylvania; Department of Surgery; Division of Trauma, Surgical Critical Care and Emergency Surgery, Philadelphia, United States. Yasin, Kara, Health Sciences University, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey. Evika, Karamagioli, School of Medicine, National and Kapodistrian University of Athens, Greece, NKUA, Filothei, Greece. Aleksandar, Karamarkovia, Surgical Clinic “Nikola Spasia,” Faculty of Medicine University of Belgrade, Belgrade, Serbia and Montenegro. Ioannis, Katsaros, Department of Surgery, Metaxa Cancer Hospital, Piraeus, Greece. Alfie, J, Kavalakat, Department of General Surgery, . Jubilee Mission Medical College & RI, Thrissur, India. Aristotelis, Kechagias, Department of General and Digestive Surgery, Kanta-Häme Central Hospital, Hämeenlinna, Finland. Jakub, Kenig, Department of General, Gastrointestinal, Oncologic Surgery and Transplantology, Krakow, Poland. Boris, Juli, Kessel, Hillel Yaffe Medical Center, Hadera, Israel. Jim, S, Khan, Portsmouth Hospitals University NHS trust, Portsmouth, United Kingdom. Vladimir, Khokha, Head surgeon, City Hospital, Mozyr, Belarus. Jae Il, Kim, Department of Surgery, Inje University Ilsan Paik Hospital, Goyang, Korea, South. Andrew, Wallace, Kirkpatrick, Departments of Surgery and Critical Care and the TeleMentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group, Calgary, Canada. Roberto, Klappenbach, Fundación Trauma, Ciudad AutÃ3noma de Buenos Aires, Argentina. Yoshiro, Kobe, Fujita Health University Hospital, Toyoake, Japan. Efstratios, Kofopoulos Lymperis, Attikon hospital department of general surgery, Athens, Greece. Kenneth, Yuh Yen, Kok, Pengiran Anak Puteri Rashidah Saadatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei. VICTOR, KONG, Department of Surgery, University of KwaZulu Natal, Durban, South Africa. Dimitris, P, Korkolis, Department of Surgical Oncology Hellenic Anticancer Hospital “Saint Savvas,” Athens, Greece. Georgios, Koukoulis, General Surgery, General Hospital of Larissa, Larissa, Greece. Bojan, Kovacevic, UMC Zvezdara, Clinic for Surgery, Belgrade, Serbia and Montenegro. Vitor, Favali, Kruger, Department of trauma surgery—University of Campinas, Campinas, Brazil. Igor, A., Kryvoruchko, Kharkiv National Medical University, Department of Surgery No. 2, Kharkiv, Ukraine. Hayato, Kurihara, Emergency Surgery and Trauma Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy. Akira, Kuriyama, Emergency and Critical Care Center, Kurashiki Central Hospital, Kurashiki, Japan. Aitor, Landaluce-Olavarria, Surgery department. Urduliz Hospital, Urduliz, Spain. Pierfrancesco, Lapolla, Department of Surgery “Pietro Valdoni,” Sapienza University of Rome, Rome, Italy. Leo, Licari, Department of Surgery. Buccheri La Ferla Hospital—Palermo, Palermo, Italy. Giorgio, Lisi, Department of Surgery, Sant’Eugenio Hospital, Rome, Italy. Andrey, Litvin, Department of Surgical Disciplines, Immanuel Kant Baltic Federal University, Regional Clinical Hospital, Kaliningrad, Russia. Aintzane, Lizarazu, General Surgery, Hospital Universitario Donostia, Donostia, Spain. Heura, Llaquet Bayo, General Surgery. Corporación Sanitaria Parc Taulí, Sabadell, Spain. Varut, Lohsiriwat, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. Claudia, Cristina, Lopes Moreira, Donostia University Hospital, San Sebastian, Spain. Eftychios, Lostoridis, Department of Surgery, Kavala General Hospital, Kavala, Greece. Agustãn Tovar Luna, Surgery Department, Mexico City, Mexico. Davide, Luppi, General And Emergency Surgery—ASMN IRCCS Reggio Emilia, Reggio Emilia, Italy. Gustavo, Miguel, Machain V., Universidad Nacional de Asuncion, ASUNCIÓN, Paraguay. Marc, Maegele, Department of Trauma and Orthopedic Surgery, Insitute for Research in Operative Medicine (IFOM), Cologne-Merheim Medical Center (CMMC), University Witten/Herdecke, Cologne, Germany. Daniele, Maggiore, Nouvelle Clinique Vert Pré, Geneve, Switzerland. Stefano, Magnone, General Surgery ASST Papa Giovanni XXIII, Bergamo, Italy. Ronald, V, Maier, Surgery, Harborview Medical Center, University of Washington, Seatlle, WA, United States. Ronald, v, Maier, Department of Surgery, Harborview Medical Center, University of Washington, Seattle, United States. Piotr, Major, Jagiellonian University Medical College, KrakÃ3w, Poland. Mallikarjuna, Manangi, General Surgery, Bangalore Medical College & Research Institute, Bangalore, India. andrea, manetti, University Hospital CAREGGI—Digestive Surgery Unit, Firenze, Italy. Baris, Mantoglu, Sakarya University Research and Educational Hospital, Department of General Surgery, Sakarya, Turkey. Chiara, Marafante, Department of General Surgery, Ospedale degli Infermi, Rivoli, Rivoli, Italy. federico, mariani, Gen and Emer Surg Department, Siena, Italy. Athanasios, Marinis, Third Department of Surgery, Tzaneio General Hospital, Piraeus, Greece. Evandro, Antonio Sbalcheiro, Mariot, Emergency Surgery Group—Department of Surgery—University Hospital of Universidade Estadual de Ponta Grossa, Ponta Grossa, Brazil. Giuseppe Roberto, Marseglia, Department of Architecture and Engineering, University of Pavia, Pavia, Italy. Aleix, Martãnez-Pérez, Department of General and Digestive Surgery. Hospital Universitario Doctor Peset, Valencia, Spain. Gennaro, Martines, General Surgery Unit Azienda Ospedaliero Universitaria Policlinico, Bari, Italy. Aleix, Martinez Perez, Department of General and Digestive Surgery. Hospital Universitario Doctor Peset., Valencia, Spain. Costanza, Martino, Cesena Hospital, Cesena, Italy. Pietro, Mascagni, Institute of Image-Guided Surgery, IHU-Strasbourg, Strasbourg, France. Damien, Massalou, Acute care surgery, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur, Nice, France, Nice, France. Belén, MatÃas-GarcÃa, Hospital Universitario PrÃncipe de Asturias, Alcalá de Henares, Spain. Gennaro, Mazzarella, Department of Emergency Surgery, Sapienza University of Rome, Rome, Italy. GIORGIO, MAZZAROLO, UOC CHIRURGIA GENERALE, VITTORIO VENETO, Italy. Renato, Bessa, Melo, Servisao Cirurgia Geral—Centro Hospitalar Universitario Sao Joao, Porto, Portugal. Fernando, Mendoza-Moreno, Hospital Universitario PrÃncipe de Asturias, Alcalá de Henares, Spain. Serhat, Meric, Bagcilar training and research hospital / general surgery department, Ä°stanbul, Turkey. Jeremy, Meyer, University Hospitals of Geneva, Geneva, Switzerland. Luca, Miceli, IRCCS CRO di Aviano, Pain Medicine, Aviano (PN), Italy. Nikolaos, V, Michalopoulos, Ass. Prof. of Surgery, Medical School, University of Athens, Greece, Athens, Greece. Flavio, Milana, Department of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy. Andrea, Mingoli, Department of Surgery “Pietro Valdoni,” Sapienza University of Rome, Rome, Italy. TUSHAR, S, MISHRA, DEPARTMENT OF SURGERY AND DEPARTMENT OF TRAUMA AND EMERGENCY, ALL INDIA INSTITUTE OF MEDICAL SCIENCES, BHUBANESWAR, Bhubaneswar, India. Muyed, Mohamed, Trauma and Orthopaedics, Raigmore Hospital, NHS Highlands, Inverness, United Kingdom. Musab, Isam Eldin Abbas, Mohamed, Trauma and Orthopaedic at Queen Elizabeth hospital, Birmingham, United Kingdom. Ali, Yasen, Mohamedahmed, Sandwell and West Birmingham NHS trust, Birmingham, United Kingdom. Mohammed, Jibreel Suliman, Mohammed, University Hospital Wishaw, Wishaw, United Kingdom. Rajashekar, Mohan, Department of Surgery, All India Institute of Medical Sciences, Mangalagiri, Guntur, Andhra Pradesh, India. Ernest, E, Moore, Ernest E Moore Shock Trauma Center at Denver Health, Denver, United States. Dieter, Morales-Garcia, DEPARTMENT OF SURGERY. UNIVESITY HOSPITAL “MARQUES DE VALDECILLA,” SANTANDER (CANTABRIA), Spain. MÃ¥ns, Muhrbeck, Department of Surgery in Norrköping, and Department of Biomedical and Clinical Sciences, Linköping University, Norrköping, Sweden. Francesk, Mulita, Department of Surgery, General University Hospital of Patras, Patras, Greece. Sami, Mohamed Siddig, Mustafa, Northern Ireland medical and dental training, Belfast, United Kingdom. Edoardo, Maria, Muttillo, Sapienza University of Rome, Rome, Italy. Mukhammad David, Naimzada, Laboratory of Public Health Indicators Analysis and Health Digitalization, Moscow Institute of Physics and Technology, Dolgoprudniy, Russia. Pradeep, H, Navsaria, Trauma Center, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa. Ionut, Negoi, Carol Davila University of Medicine and Pharmacy Bucharest, Emergency Hospital of Bucharest Romania, Bucharest, Romania. Luca, Nespoli, Dipartimento di Medicina e Chirurgia Università di Milano Bicocca, Italy. Christine, Nguyen, Rocky Vista University, Parker, USA. Melkamu, Kibret, Nidaw, General surgery and Pawi General Hospital, Pawi, Ethiopia. Giuseppe, Nigri, Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy. Ioannis, Nikolopoulos, Lewisham & Greenwich NHS Trust, London, United Kingdom. Donal, Brendan, O’Connor, Department of Surgery Trinity College Dublin, Dublin, Ireland. Habeeb, Damilola, Ogundipe, Department of Surgery, University College Hospital, Ibadan, Ibadan, Nigeria. Cristina, Oliveri, General surgery, Ospedale Borgomanero, Borgomanero (NO), Italy. Stefano, Olmi, Department of General and Oncologic Surgery. Policlinico San Marco, Zingonia (bg), Zingonia (Bg), Italy. Ernest, Cun Wang, Ong, Department of General Surgery, Hospital Bintulu, Bintulu, Malaysia. Luca, Orecchia, Urology Unit, Fondazione PTV Policlinico Tor Vergata, Rome, Italy. Aleksei, V, Osipov, Research institute of emergency medicine n.a. I. I. Dzhanelidze, department of urgent surgery, Saint-Petersburg, Russia. Muhammad Faeid, Othman, Department of Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu, Kelantan, Malaysia, Kota Bharu, Malaysia. Marco, Pace, General Surgery, University of Sapienza, Rome, Italy. MARIO, PACILLI, Department of Medical and Surgical Sciences University of Foggia, Foggia, Italy. Leonardo, Pagani, Antimicrobial Stewardship Program; Bolzano Central Hospital, Bolzano, Italy. Giuseppe, Palomba, Department of clinical medicine and surgery, university of Naples, Federico II, Naples, Italy. Desire’, Pantalone, Dept of Experimental and Clinical Medicine -University of Florence, Careggi University Hospital Florence, Italy, Florence, Italy. Arpad, Panyko, 4th Department of Surgery, University Hospital Bratislava, Bratislava, Slovakia. Ciro, Paolillo, Emergency Department ATTS Spedali Civili di Brescia, Brescia, Italy. Mario Virgilio, Papa, Department of Medical and Surgical Sciences, University of Padova, Padova, Italy. Dimitrios, Papaconstantinou, Third Department of Surgery, Athens, Greece. Maria, Papadoliopoulou, Fourth Department of surgery,Attikon University Hospital, Athens, Greece. Aristeidis, Papadopoulos, 1st Surgical Department, General Hospital of Nikaia, Nikaia, Greece. Davide, Papis, General Surgery, Sant’Anna Hospital, Como, Italy. Nikolaos, Pararas, Dr Sulaiman Al Habib Hospital, Surgical Department, Riyadh, Saudi Arabia. Jose, Gustavo, Parreira, Department of Surgery. Santa Casa School of Medical Sciences., Sao Paulo., Brazil. Neil, Geordie, Parry, Department of Surgery, Western University, London, Canada. Francesco, Pata, Nicola Giannettasio Hospital, Corigliano-Rossano, Italy. Tapan, Patel, Department of surgery, Baroda Medical College and S.S.G. Hospital, Vadodara, India. Simon, Paterson-Brown, Royal Infirmary University of Edinburgh, Edinburgh, United Kingdom. Giovanna, Pavone, Department of Medical and Surgical Sciences—University of Foggia, Foggia, Italy. Francesca, Pecchini, Division of General Surgery, of Emergency and New Technologies, Baggiovara Hospital, Modena, Italy, Modena, Italy. Gianluca, Pellino, Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania “Luigi Vanvitelli,” Naples, Italy. Maria, Pelloni, General and Digestive Surgery- University Hospital of Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Spain. Andrea, Peloso, Divisions of Transplantation and Visceral Surgery, Department of Surgery, University of Geneva, Geneva, Switzerland. Eduardo, Perea del Pozo, General Surgery Emergency and Trauma Surgery, Seville, Spain. Rita, Goncalves, Pereira, Centro Hospitalar Barreiro Montijo, EPE, Barreiro, Portugal. Bruno, Monteiro, Pereira, Grupo Surgical, Campinas, Brazil. Aintzane, Lizarazu, perez, General surgery, Hospital Universitario Donostia, Donostia, Spain. Teresa, Perra, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy. Gennaro, Perrone, Depeartment of emergency surgery, Parma University Hospital,, Parma, Italy. Antonio, Pesce, Delta Hospital, Azienda USL of Ferrara, Department of Surgery, University of Ferrara, Ferrara, Italy. Lorenzo, Petagna, General Surgery Residency Program, Tor Vergata University Rome, Rome, Italy. Giovanni, PETRACCA, Azienda Sanitaria Provinciale di Vibo Valentia, Vibo Valentia, Italy. Vorapong, Phupong, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. Biagio, Picardi, San Filippo Neri Hospital, ASL Roma 1, Roma, Italy. Arcangelo, Picciariello, Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy. Micaela, Piccoli, General surgery and emergency unit. Department of Surgery. AOU (azienda ospedaliero universitaria) of Modena, Modena, Italy. Daniele, Piccolo, Neurosurgery Department, University of Padua, Padua, Italy. Edoardo, Picetti, Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy. Emmanouil Pikoulis, Pikoulis, School of Medicine, National and Kapodistrian University of Athens (NKUA), Athens, Greece. Tadeja, Pintar, Abdominal Surgery Dep., UMC Ljubljana and Medical Faculty Ljubljana, Ljubljana, Slovenia. Giovanni, Pirozzolo, Emergency and General Surgery—Ospedale dell’Angelo—ULSS3 Serenissima, Venezia, Italy. Francesco, Piscioneri, Calvary Public Hospital, Canberra, Australia. Mauro, Podda, Department of Emergency Surgery, Cagliari University Hospital, Cagliari, Italy. Alberto, Porcu, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy. Francesca, Privitera, General Surgery, Ospedale Policlinico-Vittorio Emanuele, Catania, Italy. Clelia, Punzo, Department of Emergency and Organ Transplant (DETO), University “Aldo Moro” Medical School of Bari, Bari, Italy. Silvia, Quaresima, Sapienza University of Rome, department of General Surgery and surgical specialties Paride Stefanini, Rome, Italy. Martha, Alexa, Quiodettis, Trauma Surgery, Hospital Santo Tomas, Panama, Panama. Niels, Qvist, Research Unit fo Surgery, Odense University Hospital; Southern University of Denmark, Odense, Denmark. Razrim, Rahim, Universiti Sains Islam Malaysia, Nilai, Malaysia. Filipe, Ramalho de Almeida, Serviço de Cirurgia, Hospital Prof Doutor Fernando Fonseca, Amadora, Portugal. Rosnelifaizur, Bin, Ramely, Surgical Department, Universiti Sains Malaysia and Hospital USM, Kubang Kerian, Malaysia. Huseyin, Kemal, Rasa, Anadolu Medical Center, Kocaeli, Turkey. Martin, Reichert, Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Giessen, Germany. Alexander, Reinisch-Liese, Dep. of General, Visceral and Oncologic Surgery, Hospital and Clinics Wetzlar, Germany, Wetzlar, Germany. Angela, Renne, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Boston, United States. Camilla, Riccetti, University of Rome Tor Vergata, Roma, Italy. Maria, Rita, Rodriguez-Luna, Surgical Research Fellow. Research Institute Against Digestive Cancer, IRCAD, Strasbourg, France, Strasbourg, France. Daniel, Roizblatt, Hospital del Trabajador, Surgery Department, Santiago, Chile. Andrea, Romanzi, Department of General Surgery, Valduce Hospital, Como, Italy. Luigi, Romeo, UO Chirurgia Generale, Ospedale Ceccarini, Riccione, Italy. Francesco, Pietro Maria, Roscio, General Surgery, ASST Valle Olona, Busto Arsizio, Italy. Ramely, Bin, Rosnelifaizur, Department of Surgery Universiti Sains Malaysia, Kota Bharu, Malaysia. Stefano, Rossi, Department of General and Emergency Surgery, San Filippo Neri Hospital, Rome, Italy, Roma, Italy. Andres M, Rubiano, Neuroscience Institute, Universidad El Bosque, Cali, Colombia. Elena, Ruiz-Úcar, Endocrine and Bariatric-Metabolic Surgery Department, Fuenlabrada Universitary Hospital, Madrid, Spain. Boris, Evgeniev, Sakakushev, Research Institute at Medical Institute Plovdiv, General Surgery Department, Plovdiv, 4000, Bulgaria. Juan, Carlos, Salamea, Hospital Vicente Corral Moscoso, Universidad del Azuay, Cuenca, Ecuador. Ibrahima, Sall, Department of visceral surgery. Military teaching hospital., Dakar, Senegal. Lasitha, Bhagya, Samarakoon, Consultant General surgeon ,University hospitals, Leicester, United Kingdom. Fabrizio, Sammartano, Trauma Team, San Carlo Borromeo Trauma Center, ASST Santi Paolo e Carlo, Milan, Italy. Alejandro, Sanchez Arteaga, Hospital Universitario Virgen del Rocío, Sevilla, Spain. Sergi, Sanchez-Cordero, Consorci Sanitari Integral—Hospital Moises Broggi Sant Joan DespÃ, Sant Joan DespÃ, Spain. Domenico, Pietro Maria, Santoanastaso, Cesena Hospital, Cesena, Italy. Diego, Sasia, General and Oncological Surgery Unit, Santa Croce and Carle Hospital, Cuneo, Cuneo, Italy. NORIO, SATO, Ehime University Department of Emergency and Critical Care, TOON, Japan. Artem, Savchuk, Surgery Department, Putyla District Hospital, Putyla, Ukraine. Robert, Grant, Sawyer, Western michigan University Homer Stryker MD School of Medicine, Kalamazoo, United States. Giacomo, Scaioli, University of Turin, Turin, Italy. DIMITRIOS, SCHIZAS, FIRST DEPARTMENT OF SURGERY, NATIONAL AND KAPODISTRIAN UNIVERSITY OF ATHENS, ATHENS, Greece. Simone, Sebastiani, AOUI Verona Chirurgia Generale E dell’Esofago e dello Stomaco, Verona, Italy. Barbara, Seeliger, IHU-Strasbourg, Institute of Image-Guided Surgery / Strasbourg University Hospitals, Department of General, Digestive and Endocrine Surgery, Strasbourg, France. Helmut, Alfredo, Segovia Lohse, II Cátedra de ClÃnica Quirúrgica, Hospital de Clinicas. Universidad Nacional de AsunciÃ3n, San Lorenzo, Paraguay. Charalampos, Seretis, Agios Andreas General Hospital of Patras, Patras, Greece. Giacomo, Sermonesi, DIMEC, University of Bologna, Bologna, Italy. Mario, Serradilla-Martin, Department of Surgery. Miguel Servet University Hospital, Zaragoza, Spain. Vishal, G, Shelat, General Surgery, Tan Tock Seng Hospital, Singapore, Singapore. Sergei, Shlyapnikov, Surgical Infections Department Emergency Care Research Institute n.a. I.I.Djanelidze, Saint-Petersburg, Russia. Theodoros, Sidiropoulos, 4th Surgical Department, University Hospital Attikon, Athens, Greece. Romeo, Lages, Simoes, Universidade Federal de Juiz de Fora Campus Governador Valadares—UFJF/GV (Federal University of Juiz de Fora) and Universidade Vale do Rio Doce—Univale (Vale do Rio Doce University)., Governador Valadares—MG, Brazil. Leandro, Siragusa, Department of Surgical Sciences, University of Roma “Tor Vergata,” Rome, Italy. Boonying, Siribumrungwong, Thammasat University Hospital, Pathum Thani, Thailand. Mihail, Slavchev, University Hospital Eurohospital, Plovdiv, Bulgaria. Leonardo, Solaini, Department of Medical and Surgical Sciences, University of Bologna, Forli, Italy. gabriele, soldini, Ospedale Sacra Famiglia Fatebenefratelli, Erba, Italy. Andrey, Sopuev, Department of Hospital Surgery with the Course of Operative Surgery of KSMA named after I.K. Akhunbaeva, Bishkek, Kyrgyzstan. Kjetil, Soreide, Department of Gastrointestinal Surgery, Stavanger University Hospital, Norway. APOSTOLOS, SOVATZIDIS, SURGICAL DEPARTMENT, GIANNITSA GENERAL HOSPITAL, GIANNITSA, PELLA, Greece. Philip, Frank, Stahel, East Carolina University, Brody School of Medicine, Greenville, NC, United States. Matt, Strickland, University of Alberta, Edmonton, Canada. Mohamed Arif, Hameed, Sultan, Department of General Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia, Kota Kinabalu, Sabah, Malaysia, Malaysia. Ruslan, Sydorchuk, Chernivtsi Regional Emergency Hospital, Chernivtsi, Ukraine. Larysa, Sydorchuk, Bukovinian State Medical University, Chernivtsi, Ukraine. Chiara Bidoli, Muhammad, Syed, Acute Care Surgery, Hamad Medical Corporation, Doha, Qatar. Ali, Muhammad, Syed, Department of Acute Care Surgery, Hamad Medical Corporation, Doha, Qatar. Luis, Tallon-Aguilar, Surgery Department. Virgen del Rocio University Hospital, Sevilla, Spain. Andrea, Marco, Tamburini, Gastrointestinal Surgery IRCCS San Raffaele Scientific Institute, Milan, Italy. Nicolò, Tamini, Asst Monza—Ospedale San Gerardo, Colorectal surgery unit, Monza, Italy. Edward, C.T.H., Tan, Department of Surgery, Radboudumc, Nijmegen, Netherlands. Jih Huei, Tan, HSAJB, Johor Bahru, Malaysia. Antonio, Tarasconi, Emergency Surgery Department, Parma University Hospital, Parma, Italy. Nicola, Tartaglia, Department of Medical and Surgical Sciences—University of Foggia, Foggia, Italy. Giuseppe, Tartaglia, Università degli studi di Pavia, Italy . Dario, Tartaglia, Emergency Surgery Unit & Trauma Center, Pisa University Hospital, University of Pisa, Pisa, Italy. John, Vincent, Taylor, Department of Surgery. University Hospital Aintree, Liverpool, United Kingdom. Giovanni, Domenico, Tebala, Digestive and Emergency Surgery Unit, Azienda Ospedaliera S.Maria, Terni, Italy. Ricardo, Alessandro, Teixeira Gonsaga, Departamento de cirurgia—UNIFIPA, Catanduva—SP, Brazil. Michel, Teuben, Dept. Of Trauma, University Hospital Zurich, Zurich, Switzerland. Alexis, Theodorou, Department of Surgery, Aretaieio University Hospital Athens, Athens, Greece. Matti, Tolonen, Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland. Giovanni, Tomasicchio, Department of Emergency and Organ Transplant (DETO), University “Aldo Moro” Medical School of Bari, Bari, Italy. Adriana, Toro, General Surgery, Augusta Hospital, Syracusa, Italy, Italy . Beatrice, Torre, Chirurgia Tratto Alimentare, IRCCS Policlinico Sant’Orsola, Bologna, Italy. Tania, Triantafyllou, UGI Senior Clinical Fellow,Department of Surgery,Royal Infirmary of Edinburgh, Edinburgh, United Kingdom. Giuseppe Trigiante, Trigiante, General Surgery Unit, Azienda Ospedaliero Universitaria Policlinico di Bari, Italy, Italy . Marzia, Tripepi, Azienda ospedaliera universitaria Verona, Verona, Italy. Julio, Trostchansky, Servicio CIrugÃa de TÃ3rax.Hospital Maciel, Montevideo, Uruguay. Konstantinos, Tsekouras, Sismanoglio General Hospital, Athens, Athens, Greece. Victor, Turrado-Rodriguez, General and Digestive Surgery, Fundacio Sanitaria Mollet, Mollet del Valles, Spain. Roberta, Tutino, Chirurgia 3, AOU Città della Salute e della Scienza di Torino, Torino, Italy. Matteo, Uccelli, San Marco Hospital GSD, Zingonia (BG), Italy. Petar, Angelov, Uchikov, Department of Special surgery, Medical university Plovdiv, Plovdiv, Bulgaria. Bakarne Ugarte-Sierra, General Surgery Department-Galdakao University Hospital/Biocruces Bizkaia Health Research Institute, Galdakao-Usansolo, Spain. Mika, Tapani, Ukkonen, Department of gastroenterology and alimentary tract surgery, Tampere University Hospital, Tampere, Finland. Michail, Vailas, 1st Department of surgery, Laiko General hospital, Athens, Greece. Panteleimon, G, Vassiliu, 4th Surgical Department, Attikon Hospital, National and Kapodistrian University of Athens, Haidari-Athens, Greece. Alain, Garcia, Vazquez, IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France. Rita, Galeiras, Vazquez, Critical Care Unit. Complexo Hospitalario Universitario A Coruña, A Coruña, Spain. Juan, Ezequiel, Verde, Hospital Universitario Austral, Pilar, Argentina. Juan, Manuel, Verde, Institute of Image-Guided Surgery, IHU Strasbourg, Strasbourg, France. Massimiliano, Veroux, Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, Italy, Catania, Italy. Jacopo, Viganò, General Surgery 1, Fondazione IRCCS Policlinico San Matteo, Pavia, Pavia, Italy. Ramon, Vilallonga, Professor of Surgery at Universitat AutÃ2noma de Barcelona Consultant Surgeon at Vall Hebron Hospital Endocrine-Metabolic and Bariatric Unit. Robotic Surgery. Vall Hebron Barcelona Hospital Campus. Pg. De la Vall d’hebron, 119-129 080035 Barcelona, BARCELONA, Spain. Diego, Visconti, Chirurgia Generale d’Urgenza e PS—AOU Cittá della Salute e della Scienza, Torino (Turin), Italy. Alessandro, Vittori, Department of Anesthesia and Critical Care, ARCO Roma, IRCCS Ospedale Pediatrico Bambino GesÃ1, Rome, Italy. Maciej, Waledziak, Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warsaw, Poland. Tongporn Wannatoop, Department of Surgery, Faculty of Medicine Siriraj hospital, Mahidol university, Bangkok, Thailand. Lukas Werner Widmer, Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. Michael Samuel James Wilson, Department of General Surgery, Forth Valley Royal Hospital, Larbert, United Kingdom. Ting Hway Wong, Duke-National University of Singapore, Singapore, Singapore. Sofia Xenaki, Department of Surgery. University Hospital of Heraklion Crete, Heraklion Crete, Greece. Byungchul Yu, Trauma surgery, Gachon University Gil Medical center, Incheon, Korea, South. Steven Yule, Royal Infirmary University of Edinburgh, Edinburgh, United Kingdom. Sanoop Koshy Zachariah, Department of General & Minimal Access Surgery, Kims-Kerala Institute of Medical Sciences, Trivandrum, India. Georgios Zacharis, General Surgery, St.Andrew Hospital, Patra, Greece. claudia, zaghi, Chirurgia Generale, ospedale San Bortolo, Vicenza, Italy. Andee Dzulkarnaen, Zakaria, Department of Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia. Diego A. Zambrano, Departamento de Cirugia, Sociedad de Lucha Contra el Cancer—SOLCA, Guayaquil, Ecuador. Nikolaos, Zampitis, Third surgical department -Tzaneio hospital, Piraeus, Greece. Biagio, Zampogna, Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University Hospital, Rome, Italy. Simone, Zanghì, Università di Pavia, Unit of general surgery, Pavia, Italy. Konstantinos, Zapsalis, 4th Surgical Clinic Aristotle University of Thessaloniki, Thessaloniki, Greece. Fabio, Zattoni, Department of Surgical, Oncological and Gastroenterological Sciences-Urological Clinic, University of Padua, Padua, Italy. Monica, Zese, ULSS5 Polesana Department of General Surgery, Santa Maria della Misericordia Hospital, Rovigo, Italy. Silvia Pérez Farre, Hospital Arnau de Vilanova. Colorrectal surgery, Lleida, Spain. Boyko Tchavdarov, Atanasov, Medical university of Plovdiv, Propedeutics of Surgical disease, UMHAT Eurohospital, Plovdiv, Bulgaria. Veronica, Pegoraro, Ca' Foscari University of Venice, Venice, Italy. Maristella Zantedeschi, Ca' Foscari University of Venice, Venice, Italy. Elisa, Reitano, University of Eastern Piedmont, Novara, Italy. Erica Pizzocaro, University of Verona, Verona, Italy.

Funding

There are no funds to be reported.

Author information

Authors and Affiliations

Authors

Consortia

Contributions

LC and FDM conceived the idea of the study. LC and FDM wrote the research protocol. LC, FDM, LA, FaCa, SD, HK, TJL, PP, and SW reviewed the research protocol. LC and FDM took care of the data collection. LC, FDM, and MM took care of the data analysis. LC and FDM wrote the first draft of the manuscript. All authors reviewed and approved the final version of the article.

Corresponding author

Correspondence to Lorenzo Cobianchi.

Ethics declarations

Ethical approval and consent to participate

Not needed.

Consent for publication

Not applicable. The manuscript does not contain data from any person.

Competing interests

The authors declare that they have no competing interests in this article.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendices

Appendix 1

Item Category

Checklist Item

Explanation

Design

Survey design

See the survey protocol

Designed in August 2021

IRB approval and informed consent process

IRB approval

Not required

Informed consent

Not required

Data protection

Not required

Development and pre-testing

Development and testing

Pre-testing done in September and October 2021

Recruitment process and description of the sample having access to the questionnaire

Closed survey

August 2022

Contact mode

Newsletter sent on November 29th, 2021

https://www.wses.org.uk/news/decision-making-survey-a-wses-team-dynamics-study-group-initiative

Advertising the survey

Social media post (Linkedin) on November 29th, 2021

Survey administration

Web/Email

Teamdynamics2021@gmail.com

Context

WSES members

Voluntary

Yes

Incentives

Participation in the WSES Team Dynamics study group (see questions #0 & #0)

Time/Date

Opened from November 29th 2021, till August 18th 2022

Randomization of items

See the survey protocol

Adaptive questioning

See the survey protocol

Number of items

See the survey protocol

Number of screens

Three screens

Completeness check

YES

Review step

NO

Response rates

Unique site visitor

Not available

View rate

Not available

Participation rate

70%

Completion rate

100%

Preventing multiple entries from the same individual

Cookies used

Not available

IP check

Not available

Log file analysis

Not available

Registration

Not available to ensure anonymity

Analysis

Handling of incomplete questionnaires

Not applicable

Questionnaires submitted with an atypical timestamp

None

Statistical correction

None

*Web survey link: https://forms.gle/WGzfNQ7GVPgFkQcKA

Appendix 2

  1. 1.

    Are you familiar with the term SDM?

    ***Yes/No***

    1. 1.

      Yes

    2. 2.

      No

  1. 2.

    What is your understanding of SDM?

    ***open question***

  2. 3.

    On a scale from 1 to 5, where 1 = not important and 5 = very important, how would you rate the following items?

    *** Likert scale 1 to 5***

    1. 1.

      Understanding the patient’s preferences

    2. 2.

      Making clinical decisions which are aligned to the patient’s preferences

    3. 3.

      Informing the patients about all the pros and cons of the chosen treatment plan

    4. 4.

      Informing the patient about the chance of these pros and cons

    5. 5.

      Informing the patient that a decision has to be made

    6. 6.

      Allowing the patient time by making the decision in a second consultation

    7. 7.

      Spending time to investigate about the patient’s preferences

    8. 8.

      Letting the patient decide after informing him/her

    9. 9.

      Asking the patient to bring someone to the consultation

    10. 10.

      Explaining all the available treatment options

    11. 11.

      Explaining why some treatment options should be preferred

    12. 12.

      Allowing the patient to co-decide the treatment

    13. 13.

      Explaining to the patient that his/her opinion is important in making the decision

    14. 14.

      Letting the patient repeat the given information

    15. 15.

      Giving information in more ways than only verbally (e.g., leaflet, website)

  1. 4.

    On a scale from 1 to 5, where 1 = never and 5 = always, how frequently do you engage in SDM if a decision is suitable for this?

    ***Likert scale 1 to 5***

  2. 5.

    On a scale from 1 to 5, where 1 = strongly disagree and 5 = strongly agree, how would you rate the following statements?

    ***Likert scale 1 to 5***

    1. 1.

      Time should be dedicated to other tasks than SDM

    2. 2.

      Sometimes decisions are urgent and have to me made right away

    3. 3.

      SDM causes patients to question the expertise of healthcare professionals

    4. 4.

      Healthcare professionals feel that they lack knowledge about what SDM entails

    5. 5.

      Healthcare professionals forget to apply SDM as it is not part of the routine

    6. 6.

      There are many other things demanding the attention of healthcare professionals

    7. 7.

      Patients prefer to say: “You decide” or “Do what you think is best, doc”

    8. 8.

      Patients lack knowledge of treatment options

    9. 9.

      Sometimes there are communication issues (e.g., language barriers)

    10. 10.

      The inter-professional collaboration is inadequate (e.g., poor communication within the team)

    11. 11.

      Several colleagues do not believe in SDM

    12. 12.

      Multidisciplinary emergency team collaborate successfully with each other

    13. 13.

      SDM is incompatible with clinical practice guidelines

    14. 14.

      There is not enough time to apply SDM (e.g., consultation times are too short)

    15. 15.

      Some treatment options are too expensive to be taken into account.

  1. 6.

    Please describe a situation or diagnosis in emergency surgery that you find suitable for SDM

    ***open question***

  2. 7.

    On a scale from 1 to 5, where 1 = not suitable and 5 = very suitable, which are the tools that, in your opinion, may facilitate shared decision-making?

    ***Likert scale 1 to 5***

    1. 1.

      Mobile electronic medical records and online tools, including telemedicine

    2. 2.

      Training

    3. 3.

      Networking and international experiences

    4. 4.

      Multidisciplinary committees and meetings

    5. 5.

      Publications

    6. 6.

      Clinical guidelines and cases

    7. 7.

      Time spent to engage patients

    8. 8.

      Non-technical skills

    9. 9.

      Cultural competence

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cobianchi, L., Dal Mas, F., Agnoletti, V. et al. Time for a paradigm shift in shared decision-making in trauma and emergency surgery? Results from an international survey. World J Emerg Surg 18, 14 (2023). https://doi.org/10.1186/s13017-022-00464-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s13017-022-00464-6

Keywords

  • Shared decision-making
  • Clinical decision-making
  • Patient-centric care
  • Trauma and emergency surgery
  • Survey