Abstract
Purpose To address the factors that surgeons use to decide between 2 options for treatment when the evidence is inconclusive. Methods We tested the null hypothesis that the factors surgeons use do not vary by training, demographics, and practice. A total of 337 surgeons rated the importance of 7 factors when deciding between treatment and following the natural history of the disease and 12 factors when deciding between 2 operative treatments using a 5-point Likert scale between 'very important' and 'very unimportant.' Results According to the percentages of statements rated very important or somewhat important, the most popular factors influencing recommendations when evidence is inconclusive between treatment and following the natural course of the illness were 'works in my hands,' 'familiarity with the treatment,' and 'what my mentor taught me.' The most important factors when evidence shows no difference between 2 surgeries were 'fewer complications,' 'quicker recovery,' 'burns fewer bridges,' 'works in my hands' and 'familiarity with the procedure.' Europeans rated 'works in my hands' and 'cheapest/most resourceful' of significantly greater importance and 'what others are doing,' 'highest reimbursement,' and 'shorter procedure' of significantly lower importance than surgeons in the United States. Observers with fewer than 10 years in independent practice rated 'what my mentor taught me,' 'what others are doing' and 'highest reimbursement' of significantly lower importance compared to observers with 10 or more years in independent practice. Conclusions Surgeons deciding between 2 treatment options, when the evidence is inconclusive, fall back to factors that relate to their perspective and reflect their culture and circumstances, more so than factors related to the patient's perspective, although this may be different for younger surgeons. Clinical relevance Hand surgeons might benefit from consensus fallback preferences when evidence is inconclusive. It is possible that falling back to personal comfort makes us vulnerable to unhelpful commercial and societal influences.
Original language | English |
---|---|
Pages (from-to) | 1202-1208 |
Number of pages | 7 |
Journal | Journal of Hand Surgery |
Volume | 38 |
Issue number | 6 |
DOIs | |
State | Published - Jun 2013 |
Keywords
- Decision making
- Evidence-based medicine
- Treatment
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In: Journal of Hand Surgery, Vol. 38, No. 6, 06.2013, p. 1202-1208.
Research output: Contribution to journal › Article › peer-review
TY - JOUR
T1 - How surgeons make decisions when the evidence is inconclusive
AU - Hageman, Michiel G.J.S.
AU - Guitton, Thierry G.
AU - Ring, David
AU - Lee Osterman, A.
AU - Spoor, A. B.
AU - Van Der Zwan, A. L.
AU - Shrivastava, Abhay
AU - Wahegaonkar, Abhijeet L.
AU - Garcia, Aida E.G.
AU - Aita, M. A.
AU - Castillo, Alberto Pérez
AU - Marcus, Alexander
AU - Ladd, Amy
AU - Terrono, Andrew L.
AU - Gutow, Andrew P.
AU - Schmidt, Andrew
AU - Wang, Angela A.
AU - Eschler, Anica
AU - Miller, Anna N.
AU - Wikerøy, Annette K.B.
AU - Barquet, Antonio
AU - Armstrong, April D.
AU - Van Vugt, Arie B.
AU - Bedi, Asheesh
AU - Shyam, Ashok K.
AU - Mazzocca, Augustus D.
AU - Jubel, Axel
AU - Reto, Babst H.
AU - Nolan, Betsy M.
AU - Arciero, Bob
AU - Van Den, B.
AU - Bamberger, Brent
AU - Peterson, Bret C.
AU - Crist, Brett D.
AU - Cross, Brian J.
AU - Badman, Brian L.
AU - Henley, C. Noel
AU - Ekholm, Carl
AU - Swigart, Carrie
AU - Manke, Chad
AU - Zalavras, Charalampos
AU - Goldfarb, Charles A.
AU - Cassidy, Charles
AU - Cornell, Charles
AU - Getz, Charles L.
AU - Metzger, Charles
AU - Wilson, Chris
AU - Heiss, Christian
AU - Perrotto, Christian J.
AU - Wall, Christopher J.
AU - Walsh, Christopher J.
AU - Garnavos, Christos
AU - Jiang, Chunyan
AU - Lomita, Craig
AU - Torosian, Craig M.
AU - Rikli, Daniel A.
AU - Whelan, Daniel B.
AU - Wascher, Daniel C.
AU - Hernandez, Daniel
AU - Polatsch, Daniel
AU - Beingessner, Daphne
AU - Drosdowech, Darren
AU - Tate, David E.
AU - Hak, David
AU - Rowland, David J.
AU - Kalainov, David M.
AU - Nelson, David
AU - Weiss, David
AU - McKee, Desirae M.
AU - Van Deurzen, D. F.P.
AU - Endrizzi, Donald
AU - Erol, Konul
AU - Overbeck, Joachim P.
AU - Baer, Wolfgang
AU - Schwab, Eckart
AU - Maza, Edgardo Ramos
AU - Harvey, Edward
AU - Rodriguez, Edward K.
AU - Prelog-Igler, Elisabeth
AU - Schemitsch, Emil H.
AU - Shin, Eon K.
AU - Hofmeister, Eric P.
AU - Thomas, F.
AU - Kaplan, D.
AU - Beeres, F. J.P.
AU - Suarez, Fabio
AU - Fernandes, C. H.
AU - Ernesto, Fidel
AU - Cayón, Cayón
AU - Dolatowski, Filip Celestyn
AU - Martin, Fischmeister
AU - Sierra, Francisco Javier Aguilar
AU - Lopez-Gonzalez, Francisco
AU - Walter, Frank
AU - Seibert, Franz Josef
AU - Baumgaertel, Fred
AU - Frihagen, Frede
AU - Fuchs, P. C.
AU - Huemer, Georg M.
AU - Kontakis, George
AU - Athwal, George S.
AU - Dyer, George S.M.
AU - Thomas, George
AU - Kohut, Georges
AU - Williams, Gerald
AU - Hernandez, German Ricardo
AU - Caro, Gladys Cecilia Zambrano
AU - Garrigues, Grant
AU - Merrell, Greg
AU - DeSilva, Gregory
AU - Della Rocca, Gregory J.
AU - Regazzi, Gustavo
AU - De Azevedo, Gustavo Borges Laurindo
AU - Ruggiero, Gustavo Mantovani
AU - Helling, H. J.
AU - MccUtchan, Hal
AU - Goost, Hans
AU - Kreder, Hans J.
AU - Hasenboehler, Paula M.
AU - Routman, Howard D.
AU - Van Der Heide, Huub
AU - Kleinlugtenbelt, I.
AU - McGraw, Iain
AU - Harris, Ian
AU - Ibrahim, Ibrahim Mohammad
AU - Lin, Ines C.
AU - Iossifidis, A.
AU - Trenholm, J. Andrew I.
AU - Goslings, J. Carel
AU - Wiater, J. Michael
AU - Choueka, Jack
AU - Ahn, Jaimo
AU - Kellam, James
AU - Biert, Jan
AU - Pomerance, Jay
AU - Johnson, Jeff W.
AU - Greenberg, Jeffrey A.
AU - Yao, Jeffrey
AU - Watson, Jeffry T.
AU - Giuffre, Jennifer L.
AU - Hall, Jeremy
AU - Park, Jin Young
AU - Fischer, Jochen
AU - Murachovsky, Joel
AU - Howlett, John
AU - McAuliffe, John
AU - Evans, John P.
AU - Taras, John
AU - Braman, Jonathan
AU - Hobby, Jonathan L.
AU - Rosenfeld, Jonathan
AU - Boretto, Jorge
AU - Orbay, Jorge
AU - Rubio, Jorge
AU - Ortiz, Jose A.
AU - Abboud, Joseph
AU - Conflitti, Joseph M.
AU - Vroemen, Joseph P.A.M.
AU - Adams, Julie
AU - Clarke, J. V.
AU - Kabir, K.
AU - Chivers, Karel
AU - Prommersberger, Karl Josef
AU - Segalman, Keith
AU - Lee, Kendrick
AU - Eng, Kevin
AU - Chhor, Kimberlly S.
AU - Ponsen, K. J.
AU - Jeray, Kyle
AU - Marsh, L.
AU - Poelhekke, L. M.S.J.
AU - Mica, Ladislav
AU - Borris, Lars C.
AU - Halperin, Lawrence
AU - Weiss, Lawrence
AU - Benson, Leon
AU - Elmans, Leon
AU - De Mendonca, Leonardo Alves
AU - Rocha, Leonardo
AU - Katolik, Leonid
AU - Lattanza, Lisa
AU - Taitsman, Lisa
AU - Guenter, Lob
AU - Catalano, Louis
AU - Buendia, Luis Antonio
AU - Austin, Luke S.
AU - Palmer, M. Jason
AU - De Vries, M. R.
AU - Krijnen, M. R.
AU - Bronkhorst, Maarten W.G.A.
AU - Abdel-Ghany, Mahmoud I.
AU - Van De Sande, M. A.J.
AU - Swiontkowski, Marc
AU - Rizzo, Marco
AU - Lehnhardt, Marcus
AU - Pirpiris, Marinis
AU - Baratz, Mark
AU - Lazarus, Mark D.
AU - Boyer, Martin
AU - Richardson, Martin
AU - Kastelec, Matej
AU - Mormino, Matt
AU - Budge, Matthew D.
AU - Turina, Matthias
AU - Wood, Megan M.
AU - Baskies, Michael
AU - Baumgaertner, Michael
AU - Behrman, Michael
AU - Hausman, Michael
AU - Jones, Michael
AU - LeCroy, Michael
AU - Moskal, Michael
AU - Nancollas, Michael
AU - Prayson, Michael
AU - Grafe, Michael W.
AU - Kessler, Michael W.
AU - Van Den Bekerom, Michel P.J.
AU - Mckee, Mike
AU - Merchant, Milind
AU - Tyllianakis, Minos
AU - Felipe, Naquira Escobar Luis
AU - Chen, Neal C.
AU - Saran, Neil
AU - Wilson, Neil
AU - Shortt, Nicholas L.
AU - Schep, Niels
AU - Rossiter, Nigel
AU - Lasanianos, N. G.
AU - Kanakaris, Nikolaos
AU - Weiss, Noah D.
AU - Harvey, Norah M.
AU - Van Eerten, P. V.
AU - Melvanki, Parag
AU - McCulloch, Patrick T.
AU - Martineau, Paul A.
AU - Appleton, Paul
AU - Guidera, Paul
AU - Levin, Paul
AU - Giannoudis, Peter
AU - Evans, Peter J.
AU - Jebson, Peter
AU - Kloen, Peter
AU - Krause, Peter
AU - Brink, Peter R.G.
AU - Peters, J. H.
AU - Blazar, Philip
AU - Streubel, Philipp N.
AU - Porcellini,
AU - Ina, Prashanth
AU - Prashanth, S.
AU - Solanki, Punita V.
AU - Wang, Qiugen
AU - Quell, M.
AU - Benafield, R. Bryan
AU - Haverlag, R.
AU - Peters, R. W.
AU - Varma, Rajat
AU - Nyszkiewicz, Ralf
AU - Costanzo, Ralph M.
AU - De Bedout, Ramon
AU - Ranade, Ashish S.
AU - Smith, Raymond Malcolm
AU - Abrams, Reid
AU - Fricker, Renato M.
AU - Omid, Reza
AU - Barth, Richard
AU - Buckley, Richard
AU - Jenkinson, Richard
AU - GIlbert, Richard S.
AU - Page, Richard S.
AU - Wallensten, Richard
AU - Zura, Robert D.
AU - Feibel, Robert J.
AU - Gray, Robert R.L.
AU - Tashijan, Robert
AU - Wagenmakers, Robert
AU - Pesantez, Rodrigo
AU - Van Riet, Roger
AU - Norlin, Rolf
AU - Pfeifer, Roman
AU - Liem, Ronald
AU - LiemKulick, Roy G.
AU - Rozental,
AU - Poolman, Rudolf W.
AU - Shatford, Russell
AU - Klinefelter, Ryan
AU - Calfee, Ryan P.
AU - Moghtaderi, Sam
AU - Sodha, Samir
AU - Sprujt, Sander
AU - Kakar, Sanjeev
AU - Kaplan, Saul
AU - Schandelmaier,
AU - Duncan, Scott
AU - Kluge, Sebastian
AU - Rodriguez-Elizalde, Sebastian
AU - Checchia, Sergio L.
AU - Rowinski, Sergio
AU - Dodds, Seth
AU - Hurwit, Shep
AU - Sprengel, K.
AU - Van Der Stappen, W. A.H.
AU - Kronlage, Steve
AU - Beldner, Steven
AU - McCabe, Steven J.
AU - Morgan, Steven J.
AU - Rhemrev, Steven J.
AU - Hilliard, Stuart
AU - Gosens, Taco
AU - Sasaki, Takashi
AU - Taleb, C.
AU - Pritsch, Tamir
AU - Tosounidis, Theodoros
AU - Wyrick, Theresa
AU - DeCoster, Thomas
AU - Dienstknecht, Thomas
AU - Stackhouse, Thomas G.
AU - Hughes, Thomas
AU - Wright, Thomas
AU - Ly, Thuan V.
AU - Havenhill, Timothy G.
AU - Omara, Timothy
AU - Siff, Todd
AU - McLaurin, Toni M.
AU - Wanich, Tony
AU - Rueger, Johannes M.
AU - Vallim, Frederico C.M.
AU - Sabesan, Vani J.
AU - Nikolaou, Vasileios S.
AU - Verhofstad,
AU - Knoll, Victoria D.
AU - Telang, Vidyadhar
AU - Iyer, Vishwanath M.
AU - Jokhi, Vispi
AU - Batson, W. Arnnold
AU - Willems, W. Jaap
AU - Smith, Wade R.
AU - Belangero, William Dias
AU - Wolkenfelt, J.
AU - Weil, Yoram
N1 - Funding Information: M.G.H. is supported by Dutch research grants from Marti-Keunig Eckhart Stichting and Anna Foundation .
PY - 2013/6
Y1 - 2013/6
N2 - Purpose To address the factors that surgeons use to decide between 2 options for treatment when the evidence is inconclusive. Methods We tested the null hypothesis that the factors surgeons use do not vary by training, demographics, and practice. A total of 337 surgeons rated the importance of 7 factors when deciding between treatment and following the natural history of the disease and 12 factors when deciding between 2 operative treatments using a 5-point Likert scale between 'very important' and 'very unimportant.' Results According to the percentages of statements rated very important or somewhat important, the most popular factors influencing recommendations when evidence is inconclusive between treatment and following the natural course of the illness were 'works in my hands,' 'familiarity with the treatment,' and 'what my mentor taught me.' The most important factors when evidence shows no difference between 2 surgeries were 'fewer complications,' 'quicker recovery,' 'burns fewer bridges,' 'works in my hands' and 'familiarity with the procedure.' Europeans rated 'works in my hands' and 'cheapest/most resourceful' of significantly greater importance and 'what others are doing,' 'highest reimbursement,' and 'shorter procedure' of significantly lower importance than surgeons in the United States. Observers with fewer than 10 years in independent practice rated 'what my mentor taught me,' 'what others are doing' and 'highest reimbursement' of significantly lower importance compared to observers with 10 or more years in independent practice. Conclusions Surgeons deciding between 2 treatment options, when the evidence is inconclusive, fall back to factors that relate to their perspective and reflect their culture and circumstances, more so than factors related to the patient's perspective, although this may be different for younger surgeons. Clinical relevance Hand surgeons might benefit from consensus fallback preferences when evidence is inconclusive. It is possible that falling back to personal comfort makes us vulnerable to unhelpful commercial and societal influences.
AB - Purpose To address the factors that surgeons use to decide between 2 options for treatment when the evidence is inconclusive. Methods We tested the null hypothesis that the factors surgeons use do not vary by training, demographics, and practice. A total of 337 surgeons rated the importance of 7 factors when deciding between treatment and following the natural history of the disease and 12 factors when deciding between 2 operative treatments using a 5-point Likert scale between 'very important' and 'very unimportant.' Results According to the percentages of statements rated very important or somewhat important, the most popular factors influencing recommendations when evidence is inconclusive between treatment and following the natural course of the illness were 'works in my hands,' 'familiarity with the treatment,' and 'what my mentor taught me.' The most important factors when evidence shows no difference between 2 surgeries were 'fewer complications,' 'quicker recovery,' 'burns fewer bridges,' 'works in my hands' and 'familiarity with the procedure.' Europeans rated 'works in my hands' and 'cheapest/most resourceful' of significantly greater importance and 'what others are doing,' 'highest reimbursement,' and 'shorter procedure' of significantly lower importance than surgeons in the United States. Observers with fewer than 10 years in independent practice rated 'what my mentor taught me,' 'what others are doing' and 'highest reimbursement' of significantly lower importance compared to observers with 10 or more years in independent practice. Conclusions Surgeons deciding between 2 treatment options, when the evidence is inconclusive, fall back to factors that relate to their perspective and reflect their culture and circumstances, more so than factors related to the patient's perspective, although this may be different for younger surgeons. Clinical relevance Hand surgeons might benefit from consensus fallback preferences when evidence is inconclusive. It is possible that falling back to personal comfort makes us vulnerable to unhelpful commercial and societal influences.
KW - Decision making
KW - Evidence-based medicine
KW - Treatment
UR - http://www.scopus.com/inward/record.url?scp=84878247647&partnerID=8YFLogxK
U2 - 10.1016/j.jhsa.2013.02.032
DO - 10.1016/j.jhsa.2013.02.032
M3 - Article
C2 - 23647639
AN - SCOPUS:84878247647
SN - 0363-5023
VL - 38
SP - 1202
EP - 1208
JO - Journal of Hand Surgery
JF - Journal of Hand Surgery
IS - 6
ER -