How surgeons make decisions when the evidence is inconclusive

Michiel G.J.S. Hageman, Thierry G. Guitton, David Ring, A. Lee Osterman, A. B. Spoor, A. L. Van Der Zwan, Abhay Shrivastava, Abhijeet L. Wahegaonkar, Aida E.G. Garcia, M. A. Aita, Alberto Pérez Castillo, Alexander Marcus, Amy Ladd, Andrew L. Terrono, Andrew P. Gutow, Andrew Schmidt, Angela A. Wang, Anica Eschler, Anna N. Miller, Annette K.B. WikerøyAntonio Barquet, April D. Armstrong, Arie B. Van Vugt, Asheesh Bedi, Ashok K. Shyam, Augustus D. Mazzocca, Axel Jubel, Babst H. Reto, Betsy M. Nolan, Bob Arciero, B. Van Den, Brent Bamberger, Bret C. Peterson, Brett D. Crist, Brian J. Cross, Brian L. Badman, C. Noel Henley, Carl Ekholm, Carrie Swigart, Chad Manke, Charalampos Zalavras, Charles A. Goldfarb, Charles Cassidy, Charles Cornell, Charles L. Getz, Charles Metzger, Chris Wilson, Christian Heiss, Christian J. Perrotto, Christopher J. Wall, Christopher J. Walsh, Christos Garnavos, Chunyan Jiang, Craig Lomita, Craig M. Torosian, Daniel A. Rikli, Daniel B. Whelan, Daniel C. Wascher, Daniel Hernandez, Daniel Polatsch, Daphne Beingessner, Darren Drosdowech, David E. Tate, David Hak, David J. Rowland, David M. Kalainov, David Nelson, David Weiss, Desirae M. McKee, D. F.P. Van Deurzen, Donald Endrizzi, Konul Erol, Joachim P. Overbeck, Wolfgang Baer, Eckart Schwab, Edgardo Ramos Maza, Edward Harvey, Edward K. Rodriguez, Elisabeth Prelog-Igler, Emil H. Schemitsch, Eon K. Shin, Eric P. Hofmeister, F. Thomas, D. Kaplan, F. J.P. Beeres, Fabio Suarez, C. H. Fernandes, Fidel Ernesto, Cayón Cayón, Filip Celestyn Dolatowski, Fischmeister Martin, Francisco Javier Aguilar Sierra, Francisco Lopez-Gonzalez, Frank Walter, Franz Josef Seibert, Fred Baumgaertel, Frede Frihagen, P. C. Fuchs, Georg M. Huemer, George Kontakis, George S. Athwal, George S.M. Dyer, George Thomas, Georges Kohut, Gerald Williams, German Ricardo Hernandez, Gladys Cecilia Zambrano Caro, Grant Garrigues, Greg Merrell, Gregory DeSilva, Gregory J. Della Rocca, Gustavo Regazzi, Gustavo Borges Laurindo De Azevedo, Gustavo Mantovani Ruggiero, H. J. Helling, Hal MccUtchan, Hans Goost, Hans J. Kreder, Paula M. Hasenboehler, Howard D. Routman, Huub Van Der Heide, I. Kleinlugtenbelt, Iain McGraw, Ian Harris, Ibrahim Mohammad Ibrahim, Ines C. Lin, A. Iossifidis, J. Andrew I. Trenholm, J. Carel Goslings, J. Michael Wiater, Jack Choueka, Jaimo Ahn, James Kellam, Jan Biert, Jay Pomerance, Jeff W. Johnson, Jeffrey A. Greenberg, Jeffrey Yao, Jeffry T. Watson, Jennifer L. Giuffre, Jeremy Hall, Jin Young Park, Jochen Fischer, Joel Murachovsky, John Howlett, John McAuliffe, John P. Evans, John Taras, Jonathan Braman, Jonathan L. Hobby, Jonathan Rosenfeld, Jorge Boretto, Jorge Orbay, Jorge Rubio, Jose A. Ortiz, Joseph Abboud, Joseph M. Conflitti, Joseph P.A.M. Vroemen, Julie Adams, J. V. Clarke, K. Kabir, Karel Chivers, Karl Josef Prommersberger, Keith Segalman, Kendrick Lee, Kevin Eng, Kimberlly S. Chhor, K. J. Ponsen, Kyle Jeray, L. Marsh, L. M.S.J. Poelhekke, Ladislav Mica, Lars C. Borris, Lawrence Halperin, Lawrence Weiss, Leon Benson, Leon Elmans, Leonardo Alves De Mendonca, Leonardo Rocha, Leonid Katolik, Lisa Lattanza, Lisa Taitsman, Lob Guenter, Louis Catalano, Luis Antonio Buendia, Luke S. Austin, M. Jason Palmer, M. R. De Vries, M. R. Krijnen, Maarten W.G.A. Bronkhorst, Mahmoud I. Abdel-Ghany, M. A.J. Van De Sande, Marc Swiontkowski, Marco Rizzo, Marcus Lehnhardt, Marinis Pirpiris, Mark Baratz, Mark D. Lazarus, Martin Boyer, Martin Richardson, Matej Kastelec, Matt Mormino, Matthew D. Budge, Matthias Turina, Megan M. Wood, Michael Baskies, Michael Baumgaertner, Michael Behrman, Michael Hausman, Michael Jones, Michael LeCroy, Michael Moskal, Michael Nancollas, Michael Prayson, Michael W. Grafe, Michael W. Kessler, Michel P.J. Van Den Bekerom, Mike Mckee, Milind Merchant, Minos Tyllianakis, Naquira Escobar Luis Felipe, Neal C. Chen, Neil Saran, Neil Wilson, Nicholas L. Shortt, Niels Schep, Nigel Rossiter, N. G. Lasanianos, Nikolaos Kanakaris, Noah D. Weiss, Norah M. Harvey, P. V. Van Eerten, Parag Melvanki, Patrick T. McCulloch, Paul A. Martineau, Paul Appleton, Paul Guidera, Paul Levin, Peter Giannoudis, Peter J. Evans, Peter Jebson, Peter Kloen, Peter Krause, Peter R.G. Brink, J. H. Peters, Philip Blazar, Philipp N. Streubel, Porcellini, Prashanth Ina, S. Prashanth, Punita V. Solanki, Qiugen Wang, M. Quell, R. Bryan Benafield, R. Haverlag, R. W. Peters, Rajat Varma, Ralf Nyszkiewicz, Ralph M. Costanzo, Ramon De Bedout, Ashish S. Ranade, Raymond Malcolm Smith, Reid Abrams, Renato M. Fricker, Reza Omid, Richard Barth, Richard Buckley, Richard Jenkinson, Richard S. GIlbert, Richard S. Page, Richard Wallensten, Robert D. Zura, Robert J. Feibel, Robert R.L. Gray, Robert Tashijan, Robert Wagenmakers, Rodrigo Pesantez, Roger Van Riet, Rolf Norlin, Roman Pfeifer, Ronald Liem, Roy G. LiemKulick, Rozental, Rudolf W. Poolman, Russell Shatford, Ryan Klinefelter, Ryan P. Calfee, Sam Moghtaderi, Samir Sodha, Sander Sprujt, Sanjeev Kakar, Saul Kaplan, Schandelmaier, Scott Duncan, Sebastian Kluge, Sebastian Rodriguez-Elizalde, Sergio L. Checchia, Sergio Rowinski, Seth Dodds, Shep Hurwit, K. Sprengel, W. A.H. Van Der Stappen, Steve Kronlage, Steven Beldner, Steven J. McCabe, Steven J. Morgan, Steven J. Rhemrev, Stuart Hilliard, Taco Gosens, Takashi Sasaki, C. Taleb, Tamir Pritsch, Theodoros Tosounidis, Theresa Wyrick, Thomas DeCoster, Thomas Dienstknecht, Thomas G. Stackhouse, Thomas Hughes, Thomas Wright, Thuan V. Ly, Timothy G. Havenhill, Timothy Omara, Todd Siff, Toni M. McLaurin, Tony Wanich, Johannes M. Rueger, Frederico C.M. Vallim, Vani J. Sabesan, Vasileios S. Nikolaou, Verhofstad, Victoria D. Knoll, Vidyadhar Telang, Vishwanath M. Iyer, Vispi Jokhi, W. Arnnold Batson, W. Jaap Willems, Wade R. Smith, William Dias Belangero, J. Wolkenfelt, Yoram Weil

Research output: Contribution to journalArticle

14 Scopus citations

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 languageEnglish (US)
Pages (from-to)1202-1208
Number of pages7
JournalJournal of Hand Surgery
Volume38
Issue number6
DOIs
StatePublished - Jun 2013
Externally publishedYes

Keywords

  • Decision making
  • Evidence-based medicine
  • Treatment

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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    Hageman, M. G. J. S., Guitton, T. G., Ring, D., Lee Osterman, A., Spoor, A. B., Van Der Zwan, A. L., Shrivastava, A., Wahegaonkar, A. L., Garcia, A. E. G., Aita, M. A., Castillo, A. P., Marcus, A., Ladd, A., Terrono, A. L., Gutow, A. P., Schmidt, A., Wang, A. A., Eschler, A., Miller, A. N., ... Weil, Y. (2013). How surgeons make decisions when the evidence is inconclusive. Journal of Hand Surgery, 38(6), 1202-1208. https://doi.org/10.1016/j.jhsa.2013.02.032