Cook Sharon A, Rosser Robert, James M Ian, Kaney Sue, Salmon Peter
St. Helens and Knowsley Hospitals National Health Service Trust, Whiston Hospital, Prescot, Merseyside, United Kingdom.
Med Decis Making. 2007 May-Jun;27(3):311-20. doi: 10.1177/0272989X07300607.
Current guidelines for surgeons' decisions about whether to offer cosmetic surgery are ineffective. Therefore, surgeons have to make difficult decisions on a case-by-case basis. The authors sought to identify the patient variables that influence surgeons' decisions in practice.
A qualitative study first delineated, from observation of consultations and interviews with surgeons and other staff, variables that might influence their decisions. Then, in a cross-sectional survey of patients seeking cosmetic surgery, the authors measured these variables and tested whether they predicted the surgeons' decisions to offer surgery.
Participants were 6 consultant plastic surgeons who assess cosmetic surgery referrals and 276 new patients aged 16 years or older referred to these surgeons.
The qualitative study suggested that, as well as clinical factors (the probability of a satisfactory surgical outcome and the risks v. benefits of surgery), surgery was more likely to be offered where it was of low cost (i.e., minor skin surgery), physical symptoms or dysfunction were present, and abnormality of appearance was extreme. The role of patients' quality of life was unclear. The quantitative study confirmed that the probability of surgery was increased where requests were for minor skin procedures and by abnormality of patients' appearance. In patients seeking major body procedures, surgery was less likely when patients reported poor quality of life.
Surgeons' decisions about whether to offer elective cosmetic surgery follow systematic rules. By incorporating the factors that surgeons use in their decision making, more effective guidelines about elective cosmetic surgery provision than are presently available could be developed.
目前关于外科医生决定是否进行整容手术的指导方针效果不佳。因此，外科医生不得不逐案做出艰难的决定。作者试图确定在实际操作中影响外科医生决策的患者变量。
一项定性研究首先通过观察会诊以及与外科医生和其他工作人员的访谈，确定可能影响他们决策的变量。然后，在一项对寻求整容手术患者的横断面调查中，作者测量了这些变量，并测试它们是否能预测外科医生提供手术的决定。
参与者包括6名评估整容手术转诊的整形外科顾问医生以及转介给这些医生的276名16岁及以上的新患者。
定性研究表明，除了临床因素（手术结果令人满意的可能性以及手术的风险与益处）外，在手术成本较低（即小型皮肤手术）、存在身体症状或功能障碍以及外观异常极端的情况下，更有可能提供手术。患者生活质量的作用尚不清楚。定量研究证实，当要求进行小型皮肤手术以及患者外观异常时，手术的可能性会增加。在寻求大型身体手术的患者中，当患者报告生活质量较差时，手术的可能性较小。
外科医生关于是否提供择期整容手术的决定遵循系统规则。通过纳入外科医生在决策中使用的因素，可以制定出比目前更有效的择期整容手术提供指导方针。
