Shared Decision-Making in Colon and Rectal Surgery

The practice of medicine has evolved over time away from a paternalistic model toward one that prioritizes patient autonomy, values, and preferences. This is especially relevant, and complex, for colon and rectal surgery, where decisions often involve nuanced trade-offs between oncologic outcomes, functional preservation, and quality of life. This issue of Clinics in Colon and Rectal Surgery is dedicated to exploring the evolving role of shared decision-making (SDM) in our field, highlighting both its promise and its challenges across a spectrum of clinical scenarios.

SDM is more than a communication strategy; it is a collaborative process that integrates the best available evidence with patient values and goals. As colorectal surgeons, we are increasingly called upon to navigate decisions that are not purely clinical but deeply personal—whether choosing between permanent ileostomy and restorative procedures in ulcerative colitis, or weighing operative versus nonoperative management in diverticulitis or rectal cancer. This issue aims to equip readers with a deeper understanding of how SDM can be effectively implemented in these contexts and more.

The issue begins with foundational insights into the principles and evidence base of SDM in surgery, followed by focused articles that apply these concepts to specific pathologies. Topics include decision-making in ulcerative colitis, diverticulitis, rectal cancer, and Lynch syndrome, as well as the use of decision aids and electronic medical records to support patient-centered care. Special attention is given to populations with unique needs, such as elderly patients and those facing end-of-life decisions. The volume also explores the role of patient-oriented research and artificial intelligence in shaping future directions for SDM.

By the end of this issue, readers will be better equipped to recognize when SDM is appropriate, understand the barriers faced by both patients and surgeons, and apply SDM principles to improve clinical outcomes and patient satisfaction. We hope this collection of articles will serve not only as a practical guide but also as a catalyst for further innovation and research in patient-centered colorectal surgical care.

Jonathan S. Abelson, MD, MS

Publication History

Article published online:
23 December 2025