SP4.07 Changing Practice in Acute Appendicitis: Patients and Surgeons views

Introduction Implementing change in practice takes on average, 17 years and is multi-factorial. Acute appendicitis, the most common general surgical emergency worldwide, is traditionally treated with surgery. Evidence and guidelines recommend treatment with antibiotics alone as a suitable alternative in uncomplicated appendicitis, yet this remains underused in practice. We investigated why antibiotic treatment is underused from patients and surgeons perspectives. Methods Patients, aged 18 and over, treated for acute appendicitis and U.K. General Surgeons (ST3 and above) involved in emergency surgery were invited to participate. Participants undertook audio-recorded semi-structured interviews. Data were analysed using thematic analysis. Results 22 patients, 13 female and 9 males. 16 surgeons, 8 ST3 and above, and 8 consultants. Numerous themes were identified. Patients recognised the importance of communication and expressed a desire to be involved in decision making, however, many had paternalistic attitudes; “Doctor knows best”. Life circumstances including employment and childcare influenced their decision making. Many patients were unaware of antibiotics as a treatment option, with some having concerns about treatment failure. Surgeons frequently had paternalistic communication styles. Surgeons recognised their communication style could influence patients' decision making. Surgeons had concerns regarding treatment failure, missed malignancy and loss of training opportunities. Surgeons had varying opinions of evidence quality and recognised a reluctance to change from established practice. Conclusions There are numerous barriers and facilitators to introducing antibiotic therapy for acute appendicitis into routine clinical practice. The themes identified will be used to guide an implementation strategy which may apply to other surgical conditions.