Implementing Nonoperative Treatment Strategy for Simple Pediatric Appendicitis: A Qualitative Study.

Area of Science:

• Pediatric surgery
• Healthcare implementation science

Background:

• Nonoperative treatment (NOT) with antibiotics for simple appendicitis in children may reduce surgery-related complications.
• Implementing new treatment strategies into routine clinical practice presents challenges.

Purpose of the Study:

• To identify barriers and facilitators for the implementation of nonoperative treatment (NOT) for children with simple appendicitis.

Main Methods:

• Conducted 14 semistructured interviews and a focus group with diverse stakeholders.
• Included health insurance/hospital policymakers, surgical clinicians, and patients/parents.
• Utilized qualitative analysis, open coding, and a healthcare innovations framework.

Main Results:

• Stakeholder reluctance towards NOT stems from appendectomy's perceived safety and routine nature.
• Clinicians emphasize the need for NOT inclusion in national guidelines for uptake.
• More evidence and experience are required to identify suitable patients for NOT.
• Treatment choice depends on individual patient preferences due to differing risks and benefits.

Conclusions:

• Addressing perceptions of NOT versus operative treatment is crucial for implementation.
• Incorporating individual patient preferences through shared decision-making is the primary step for NOT implementation.