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J Hand Surg Am. 2013 Jun;38(6):1202-8. doi: 10.1016/j.jhsa.2013.02.032. Epub 2013 May 4.

How surgeons make decisions when the evidence is inconclusive.

Collaborators (330)

Osterman A, Spoor AB, van der Zwan AL, Shrivastava A, Wahegaonkar AL, Aida E, Aita MA, Castillo AP, Marcus A, Ladd A, Terrono AL, Gutow AP, Schmidt A, Wang AA, Eschler A, Miller AN, Wikerøy AK, Barquet A, Armstrong AD, van Vugt AB, Bedi A, Shyam AK, Mazzocca AD, Jubel A, Babst RH, Nolan BM, Arciero B, Bremer V, Bamberger B, Peterson BC, Crist BD, Cross BJ, Badman BL, Henley C, Ekholm C, Swigart C, Manke C, Zalavras C, Goldfarb CA, Cassidy C, Cornell C, Getz CL, Metzger C, Wilson C, Heiss C, Perrotto CJ, Wall CJ, Walsh CJ, Garnavos C, Jiang C, Lomita C, Torosian CM, Rikli DA, Whelan DB, Wascher DC, Hernandez D, Polatsch D, Beingessner D, Drosdowech D, Tate DE Jr, Hak D, Rowland DJ, Kalainov DM, Nelson D, Weiss D, McKee DM, van Deurzen DF, Endrizzi D, Erol K, Overbeck JP, Baer W, Schwab E, Maza ER, Harvey E, Rodriguez EK, Preloggler E, Schemitsch EH, Shin EK, Hofmeister EP, Kaplan TD, Beeres FJ, Suarez F, Fernandes CH, Cayón FE, Dolatowski FC, Martin F, Sierra FJ, Lopez-Gonzalez F, Walter F, Seibert FJ, Baumgaertel F, Frihagen F, Fuchs PC, Huemer GM, Kontakis G, Athwal GS, Dyer GS, Thomas G, Kohut G, Williams G, Hernandez GR, Caro GC, Garrigues G, Merrell G, DeSilva G, Della Rocca GJ, Regazzi G, de Azevedo GB, Ruggiero GM, Helling HJ, MccUtchan H, Goost H, Kreder HJ, Hasenboehler PM, Routman HD, van der Heide H, Kleinlugtenbelt I, McGraw I, Harris I, Ibrahim IM, Lin IC, Iossifidis A, Andrew J, Trenholm I, Goslings J, Wiater J, Choueka J, Ahn J, Kellam J, Biert J, Pomerance J, Johnson JW, Greenberg JA, Yao J, Watson JT, Giuffre JL, Hall J, Park JY, Fischer J, Murachovsky J, Howlett J, McAuliffe J, Evans JP, Taras J, Braman J, Hobby JL, Rosenfeld J, Boretto J, Orbay J, Rubio J, Ortiz JA Jr, Abboud J, Conflitti JM, Vroemen JP, Adams J, Clarke JV, Kabir K, Chivers K, Prommersberger KJ, Segalman K, Lee K, Eng K, Chhor KS, Ponsen KJ, Jeray K, Marsh L, Poelhekke LM, Mica L, Borris LC, Halperin L, Weiss L, Benson L, Elmans L, de Mendonca LA Jr, Rocha L, Katolik L, Lattanza L, Taitsman L, Guenter L, Catalano L 3rd, Buendia LA, Austin LS, Palmer M, de Vries MR, Bronkhorst MW, Abdel-Ghany MI, Van de Sande MA, Swiontkowski M, Rizzo M, Lehnhardt M, Pirpiris M, Baratz M, Lazarus MD, Boyer M, Richardson M, Kastelec M, Mormino M, Budge MD, Turina M, Wood MM, Baskies M, Baumgaertner M, Behrman M, Hausman M, Jones M, LeCroy M, Moskal M, Nancollas M, Prayson M, Grafe MW, Kessler MW, Van den Bekerom MP, Mckee M, Merchant M, Tyllianakis M, Felipe NE, Chen NC, Saran N, Wilson N, Shortt NL, Schep N, Rossiter N, Lasanianos NG, Kanakaris N, Weiss ND, Harvey NM, van Eerten PV, Melvanki P, McCulloch PT, Martineau PA, Appleton P, Guidera P, Levin P, Giannoudis P, Evans PJ, Jebson P, Kloen P, Krause P, Brink PR, Peters JH, Blazar P, Streubel PN, Inna P, Prashanth S, Solanki PV, Wang Q, Quell M, Benafield R Jr, Haverlag R, Peters RW, Varma R, Nyszkiewicz R, Costanzo RM, de Bedout R, Ranade AS, Smith RM, Abrams R, Fricker RM, Omid R, Barth R, Buckley R, Jenkinson R, GIlbert RS, Page RS, Wallensten R, Zura RD, Feibel RJ, Gray RR, Tashijan R, Wagenmakers R, Pesantez R, van Riet R, Norlin R, Pfeifer R, Liem R, Kulick RG, Poolman RW, Shatford R, Klinefelter R, Calfee RP, Moghtaderi S, Sodha S, Sprujt S, Kakar S, Kaplan S, Duncan S, Kluge S, Rodriguez-Elizalde S, Checchia SL, Rowinski S, Dodds S, Hurwit S, Sprengel K, van der Stappen WA, Kronlage S, Belded S, Morgan SJ, Rhemrev SJ, Hilliard S, Gosens T, Sasaki T, Taleb C, Pritsch T, Tosounidis T, Wyrick T, DeCoster T, Dienstknecht T, Stackhouse TG, Hughes T, Wright T, Ly TV, Havenhill TG, Omara T, Siff T, McLaurin TM, Wanich T, Rueger JM, Vallim FC, Sabesan VJ, Nikolaou VS, Knoll VD, Telang V, Iyer VM, Jokhi V, Batson W, Willems W, Smith WR, Belangero WD, Wolkenfelt J, Weil Y.

Author information

1
dring@partners.org

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.

PMID:
23647639
DOI:
10.1016/j.jhsa.2013.02.032
[Indexed for MEDLINE]
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