Department of Neurosurgery, Karolinska Hospital, 171 76 Stockholm, Sweden.
Acta Neurochir (Wien). 2013 Aug;155(8):1425-9. doi: 10.1007/s00701-013-1796-8. Epub 2013 Jun 23.
Clinical decision-making involves a complex interaction between patients and caregivers. The medical knowledge and values of caregivers are essential for treatment recommendations. This study was undertaken to evaluate treatment recommendations by a group of Scandinavian neurosurgeons before and after an expert lecture on glioblastoma surgery.
An interactive voting system was used to record responses to four questions regarding glioblastoma management before and after a 25-min lecture on the benefit of radical glioblastoma surgery.
The majority of the audience aimed at radical surgery combined with radiotherapy before (76%) and after (88%) the lecture. The proportion who recommended immediate postoperative follow-up by MRI increased from 34% to 75%. Fourteen percent (before) and 45% (after) recommended renewed surgery to remove small residuals in patients, while 52% (before) and 60% (after) would have wanted to be re-operated if they themselves had been patients.
The views on optimum management differed widely in a relatively homogeneous group of neurosurgeons. The lecture had a major impact on decision-making. A large proportion of the attendees recommended different management strategies for themselves and for their patients. The findings indicated the need to analyze the evaluation of medical knowledge, discuss the ethics of decision-making and encourage second opinions for serious neurosurgical decisions.
临床决策涉及患者和护理人员之间的复杂互动。护理人员的医学知识和价值观对于治疗建议至关重要。本研究旨在评估一组斯堪的纳维亚神经外科医生在接受关于胶质母细胞瘤手术的专家讲座前后的治疗建议。
使用交互式投票系统记录了 4 个关于胶质母细胞瘤管理的问题的回答，这些问题在关于积极胶质母细胞瘤手术益处的 25 分钟讲座前后提出。
大多数听众在讲座前（76%）和后（88%）都倾向于激进的手术联合放疗。建议在术后立即进行 MRI 随访的比例从 34%增加到 75%。14%（前）和 45%（后）建议对患者进行再次手术以切除小的残余物，而 52%（前）和 60%（后）如果自己是患者，他们希望再次手术。
在相对同质的神经外科医生群体中，对最佳治疗的看法存在很大差异。讲座对决策产生了重大影响。很大一部分与会者为自己和患者推荐了不同的管理策略。这些发现表明，有必要分析对医学知识的评估，讨论决策的伦理问题，并鼓励对严重的神经外科决策进行二次意见。
