How surgeons make decisions when the evidence is inconclusive

Area of Science:

• Surgical Decision-Making
• Medical Practice Analysis
• Healthcare Professional Behavior

Background:

• Clinical evidence is often inconclusive when comparing treatment options.
• Surgeons must make critical decisions based on available information.
• Understanding the factors influencing these decisions is crucial for improving patient care.

Purpose of the Study:

• To investigate the factors surgeons consider when choosing between treatment options with inconclusive evidence.
• To test if these factors vary based on surgeon training, demographics, and practice.

Main Methods:

• 337 surgeons rated the importance of various factors on a 5-point Likert scale.
• Factors were assessed for decisions between treatment vs. natural history and between two surgical procedures.
• The null hypothesis stated that factors do not vary by training, demographics, and practice.

Main Results:

• Key factors for inconclusive treatment vs. natural history: "works in my hands," "familiarity," and "mentor taught me."
• Key factors for two surgeries: "fewer complications," "quicker recovery," "burns fewer bridges," "works in my hands," and "familiarity."
• European surgeons prioritized "works in my hands" and "cheapest/most resourceful" over US surgeons, who valued "what others are doing," "highest reimbursement," and "shorter procedure."
• Less experienced surgeons ( <10 years) valued "mentor taught me," "what others are doing," and "highest reimbursement" less than more experienced surgeons.

Conclusions:

• Surgeons often rely on personal, cultural, and circumstantial factors when evidence is inconclusive, rather than patient-centered factors.
• Younger surgeons may consider patient-centered factors more.
• Developing consensus preferences could mitigate risks associated with personal comfort influencing decisions, potentially reducing vulnerability to commercial or societal pressures.