Shared Decision-Making in Emergency Colorectal Cancer Surgery: A Time-Adapted Model Grounded in Relational Autonomy

Abstract

Shared decision-making (SDM) is widely recognized for integrating clinical evidence with patient values, yet standard SDM models presuppose elective conditions: ample time, intact capacity, and repeated consultations. Emergency surgery for colorectal cancer, which typically arises from obstruction, perforation, or hemorrhage, undermines these prerequisites. Irreversible, value-laden choices concerning stoma formation, the extent of resection, or non-operative care in frail older patients must be made within hours, often under impaired capacity due to pain, sepsis, and opioids. Drawing on the perspective of a colorectal surgeon at a regional university hospital in South Korea, this article analyzes why standard SDM fails in this setting and argues that this shortfall mandates reconstructing the SDM framework. Reinterpreting autonomy relationally, the study defends structured family participation as a legitimate expression of patient self-determination in the Korean context. It proposes a time-adapted SDM model that stratifies decisions by physiological urgency, incorporates the best-case/worst-case communication framework, utilizes bridging strategies such as colonic stenting to render emergency choices semi-elective, and specifies the institutional and documentation supports required by regional medical centers.