Surgeons’ Perspective of Decision Making in Recurrent Diverticulitis
Objective:. This study employs qualitative methodology to assess surgeons’ perspective on decision making in management of recurrent diverticulitis to improve patient-centered decision making. Background:. The decision to pursue colectomy for patients with recurrent diverticulitis is nuanced. Strate...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Health
2022-06-01
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| Series: | Annals of Surgery Open |
| Online Access: | http://journals.lww.com/10.1097/AS9.0000000000000157 |
| _version_ | 1797732809523068928 |
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| author | Alexander T. Hawkins, MD, MPH Russell L. Rothman, MD, MPP Timothy M. Geiger, MD, MMHC Kemberlee R. Bonnet, MA Matthew G. Mutch, MD Scott E. Regenbogen, MD, MPH David G. Schlundt, PhD David F. Penson, MD, MPH |
| author_facet | Alexander T. Hawkins, MD, MPH Russell L. Rothman, MD, MPP Timothy M. Geiger, MD, MMHC Kemberlee R. Bonnet, MA Matthew G. Mutch, MD Scott E. Regenbogen, MD, MPH David G. Schlundt, PhD David F. Penson, MD, MPH |
| author_sort | Alexander T. Hawkins, MD, MPH |
| collection | DOAJ |
| description | Objective:. This study employs qualitative methodology to assess surgeons’ perspective on decision making in management of recurrent diverticulitis to improve patient-centered decision making.
Background:. The decision to pursue colectomy for patients with recurrent diverticulitis is nuanced. Strategies to enact broad acceptance of guidelines for surgery are hindered because of a knowledge gap in understanding surgeons’ current attitudes and opinions.
Methods:. We performed semistructured interviews with board-certified North American general and colorectal surgeons who manage recurrent diverticulitis. We purposely sampled specialists by both surgeon and practice factors. An iterative inductive/deductive strategy was used to code and analyze the interviews and create a conceptual framework.
Results:. Twenty-five surgeons were enrolled over a 9-month period. There was diversity in surgeons’ gender, age, experience, training, specialty (colorectal vs general surgery), and geography. Surgeons described the difficult process to determine who receives an operation. We identified 7 major themes as well as 20 subthemes of the decision-making process. These were organized into a conceptual model. Across the spectrum of interviews, it was notable that there was a move over time from decisions based on counting episodes of diverticulitis to a focus on improving quality of life. Surgeons also felt that quality of life was more dependent on psychosocial factors than the degree of physiological dysfunction.
Conclusions:. Surgeons mostly have discarded older dogma in recommending colectomy for recurrent diverticulitis based on number and severity of episodes. Instead, decision making in recurrent diverticulitis is complex, involving multiple surgeon and patient factors and evolving over time. Surgeons struggle with this decision and education- or communication-based interventions that focus on shared decision-making warrant development. |
| first_indexed | 2024-03-12T12:19:54Z |
| format | Article |
| id | doaj.art-ab745771835743f2a69af9d8901a0ebe |
| institution | Directory Open Access Journal |
| issn | 2691-3593 |
| language | English |
| last_indexed | 2024-03-12T12:19:54Z |
| publishDate | 2022-06-01 |
| publisher | Wolters Kluwer Health |
| record_format | Article |
| series | Annals of Surgery Open |
| spelling | doaj.art-ab745771835743f2a69af9d8901a0ebe2023-08-30T06:09:59ZengWolters Kluwer HealthAnnals of Surgery Open2691-35932022-06-0132e15710.1097/AS9.0000000000000157202206000-00013Surgeons’ Perspective of Decision Making in Recurrent DiverticulitisAlexander T. Hawkins, MD, MPH0Russell L. Rothman, MD, MPP1Timothy M. Geiger, MD, MMHC2Kemberlee R. Bonnet, MA3Matthew G. Mutch, MD4Scott E. Regenbogen, MD, MPH5David G. Schlundt, PhD6David F. Penson, MD, MPH7From the * Division of General Surgery, Section of Colon & Rectal Surgery, Vanderbilt University Medical Center, Nashville, TN† Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TNFrom the * Division of General Surgery, Section of Colon & Rectal Surgery, Vanderbilt University Medical Center, Nashville, TN‡ Department of Psychology, Vanderbilt University, Nashville, TN§ Department of Surgery, Section of Colon and Rectal Surgery, Washington University School of Medicine, Saint Louis, MO∥ Division of Colorectal Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI‡ Department of Psychology, Vanderbilt University, Nashville, TN¶ Department of Urology, Vanderbilt University Medical Center, Nashville, TNObjective:. This study employs qualitative methodology to assess surgeons’ perspective on decision making in management of recurrent diverticulitis to improve patient-centered decision making. Background:. The decision to pursue colectomy for patients with recurrent diverticulitis is nuanced. Strategies to enact broad acceptance of guidelines for surgery are hindered because of a knowledge gap in understanding surgeons’ current attitudes and opinions. Methods:. We performed semistructured interviews with board-certified North American general and colorectal surgeons who manage recurrent diverticulitis. We purposely sampled specialists by both surgeon and practice factors. An iterative inductive/deductive strategy was used to code and analyze the interviews and create a conceptual framework. Results:. Twenty-five surgeons were enrolled over a 9-month period. There was diversity in surgeons’ gender, age, experience, training, specialty (colorectal vs general surgery), and geography. Surgeons described the difficult process to determine who receives an operation. We identified 7 major themes as well as 20 subthemes of the decision-making process. These were organized into a conceptual model. Across the spectrum of interviews, it was notable that there was a move over time from decisions based on counting episodes of diverticulitis to a focus on improving quality of life. Surgeons also felt that quality of life was more dependent on psychosocial factors than the degree of physiological dysfunction. Conclusions:. Surgeons mostly have discarded older dogma in recommending colectomy for recurrent diverticulitis based on number and severity of episodes. Instead, decision making in recurrent diverticulitis is complex, involving multiple surgeon and patient factors and evolving over time. Surgeons struggle with this decision and education- or communication-based interventions that focus on shared decision-making warrant development.http://journals.lww.com/10.1097/AS9.0000000000000157 |
| spellingShingle | Alexander T. Hawkins, MD, MPH Russell L. Rothman, MD, MPP Timothy M. Geiger, MD, MMHC Kemberlee R. Bonnet, MA Matthew G. Mutch, MD Scott E. Regenbogen, MD, MPH David G. Schlundt, PhD David F. Penson, MD, MPH Surgeons’ Perspective of Decision Making in Recurrent Diverticulitis Annals of Surgery Open |
| title | Surgeons’ Perspective of Decision Making in Recurrent Diverticulitis |
| title_full | Surgeons’ Perspective of Decision Making in Recurrent Diverticulitis |
| title_fullStr | Surgeons’ Perspective of Decision Making in Recurrent Diverticulitis |
| title_full_unstemmed | Surgeons’ Perspective of Decision Making in Recurrent Diverticulitis |
| title_short | Surgeons’ Perspective of Decision Making in Recurrent Diverticulitis |
| title_sort | surgeons perspective of decision making in recurrent diverticulitis |
| url | http://journals.lww.com/10.1097/AS9.0000000000000157 |
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