Differences in surgeons' perceptions of treatment risks and benefits explained 39% of the observed variation in decisions to operate across four clinical vignettes.
Cross-Sectional (n=767)
Yes
How do surgeons' perceptions of treatment risks and benefits influence their decisions to operate?
Surgeons' perceptions of treatment risks and benefits vary widely and strongly predict their decisions to operate in uncertain clinical scenarios.
Effect estimate: AD -29.6% (95% CI -31.6 to -23.8)
OBJECTIVE: To determine how surgeons' perceptions of treatment risks and benefits influence their decisions to operate. BACKGROUND: Little is known about what makes one surgeon choose to operate on a patient and another chooses not to operate. METHODS: Using an online study, we presented a national sample of surgeons (N = 767) with four detailed clinical vignettes (mesenteric ischemia, gastrointestinal bleed, bowel obstruction, appendicitis) where the best treatment option was uncertain and asked them to: (1) judge the risks (probability of serious complications) and benefits (probability of recovery) for operative and nonoperative management and (2) decide whether or not they would recommend an operation. RESULTS: Across all clinical vignettes, surgeons varied markedly in both their assessments of the risks and benefits of operative and nonoperative management (narrowest range 4%-100% for all four predictions across vignettes) and in their decisions to operate (49%-85%). Surgeons were less likely to operate as their perceptions of operative risk increased absolute difference (AD) = -29.6% from 1.0 standard deviation below to 1.0 standard deviation above mean (95% confidence interval, CI: -31.6, -23.8) and their perceptions of nonoperative benefit increased AD = -32.6% (95% CI: -32.8,--28.9). Surgeons were more likely to operate as their perceptions of operative benefit increased AD = 18.7% (95% CI: 12.6, 21.5) and their perceptions of nonoperative risk increased AD = 32.7% (95% CI: 28.7, 34.0). Differences in risk/benefit perceptions explained 39% of the observed variation in decisions to operate across the four vignettes. CONCLUSIONS: Given the same clinical scenarios, surgeons' perceptions of treatment risks and benefits vary and are highly predictive of their decisions to operate.
Sacks et al. (Tue,) conducted a cross-sectional in Surgical decision making (n=767). Assessment of clinical vignettes was evaluated on Decision to operate based on perception of operative risk (AD -29.6%, 95% CI -31.6 to -23.8). Differences in surgeons' perceptions of treatment risks and benefits explained 39% of the observed variation in decisions to operate across four clinical vignettes.