Promoting perioperative decision-making by patients

Call it patient empowerment. Vascular surgeon Dr. Luc Dubois believes patients not only want to, but should, share in the decision-making about their treatment, especially when it comes to surgery.

And he's finding new ways to make that possible.

Dr. Dubois earned his medical degree from Schulich Medicine & Dentistry in 2005 and stayed for his residency in the Department of Surgery. He now holds the position of Assistant Professor.

He is also a Clinical-Investigator, a designation which allows Dr. Dubois to devote two days a week to his research focused on the perioperative decision-making process and how it can be improved from the patient's perspective.

"Should we first find out what their decision-making preference is and not have a standard spiel, because maybe everyone doesn't want to hear the same thing," said Dr. Dubois, who took a year out of his surgical residency to complete a Master of Clinical Epidemiology degree at Western.

He said it was time well-spent. "It basically gave me the background necessary to bring my ideas to fruition. It allowed me to develop the methodology to try to find answers."

While that added training honed his research skills, the Clinical-Investigator Program allows him the time to actually do the work.

"I think the program is vitally important. Without the ability to free up your time, it's difficult to produce meaningful work. You may be able to do the odd paper here and there, but it will be hard to bring new ideas to fruition," said Dr. Dubois. "It requires a lot of dedication to fully mature the methodology to the point where you're achieving something that is new and innovative, and may change practice."

In particular, Dr. Dubois is studying different procedures in vascular surgery such as aneurism repair or revascularization.

"We traditionally look at hard outcomes like mortality, or if we put in a graft - does it stay open or not? But maybe what we really should be asking is 'How does it impact your daily life? What are some other things about the treatment that might be more important to you, like your ability to live independently, your ability to walk, your ability to be discharged home?' A lot of our patients are elderly and our surgeries are pretty invasive, and they can have some life-altering effects that are not necessarily expected or anticipated, and not always appreciated by patients."

He said there are different decision-making styles, and yes, some patients prefer to leave it up to the physician. Either way, he said, there are a lot of aids available, both visual and computer-based, to enhance the physician-patient interaction.

Dr. Dubois sumed up his research this way: "Trying to come up with new ways to look at what we do, and how it impacts patient lives. The buzzwords would be 'patient-derived outcomes' - it's a very novel concept, particularly in surgery."