The success of an anaesthetic is traditionally judged by our ability to safely get our patient through an operation. Yet, the more evolving challenge of our specialty is identifying those patients at high risk of postoperative complications where the best course of action may be no surgery at all. A further challenge is that of empowering patients to consider the available evidence to make the best decision for their circumstances.

Shared decision-making, whereby patients and clinicians collaborate to make the best evidence-based decision within the context of the patients’ values, is recognised as a vital component of perioperative care. The benefits of shared decision-making are accepted by NICE and the Centre for Perioperative Care (CPOC), yet evidence suggests we may not be doing it as well as we should. A recent CPOC survey showed that 39% of patients desired more support or information regarding treatment choices. In another study, 14% of patients expressed regret, and said that they would not have had surgery had they understood the risks and alternatives. View the ‘three-talk’ model of shared decision-making suggested by CPOC.