Department of Surgery, University of Utah, Salt Lake City, Utah; Department of Population Health Sciences, University of Utah, Salt Lake City, Utah.
Department of Internal Medicine, University of Utah, Salt Lake City, Utah.
J Surg Res. 2021 May;261:159-166. doi: 10.1016/j.jss.2020.12.019. Epub 2021 Jan 8.
We aimed to identify decision process measures associated with patient decisional regret regarding the decision to pursue elective colectomy or observation for diverticulitis.
This was a single-center cross-sectional survey study. We included adult patients treated for diverticulitis between 2014 and 2019 and excluded patients who required urgent or emergent colectomy. The primary outcome was regret regarding the decision to pursue elective surgery or observation for diverticulitis, measured using the Decision Regret Scale. We used multivariable linear regression to examine hypothesized predictors of decision regret, including decisional conflict (Decision Conflict Scale and its subscales), shared decision-making, and decision role concordance.
Of 923 eligible patients, 133 were included in the analysis. Patients had a median of five episodes of diverticulitis (interquartile range 3-8), occurring a median of 2 y (interquartile range 1-3) before survey administration. Thirty-eight patients (29%) underwent elective surgery for diverticulitis. Decision regret (Decision Regret Scale score ≥25) was present in 42 patients (32%). After controlling for surgery, gender, health status, and years since treatment, decision regret was associated with decisional conflict and inversely associated with values clarity, decision role concordance, shared decision-making, and feeling informed, supported, and effective in decision-making (all P < 0.001).
Nearly one-third of survey respondents experienced regret regarding the decision between elective surgery and observation for diverticulitis. Decision regret may be reduced through efforts to improve patient knowledge, values clarity, role concordance, and shared decision-making.
我们旨在确定与患者对是否选择接受择期结肠切除术或观察治疗憩室炎的决策后后悔相关的决策过程指标。
这是一项单中心横断面调查研究。我们纳入了 2014 年至 2019 年期间接受憩室炎治疗的成年患者，并排除了需要紧急或急诊结肠切除术的患者。主要结局是对是否选择接受择期手术或观察治疗憩室炎的决策后悔程度，使用决策后悔量表进行评估。我们使用多变量线性回归来检验决策后悔的假设预测因素，包括决策冲突（决策冲突量表及其子量表）、共享决策和决策角色一致性。
在 923 名符合条件的患者中，有 133 名患者纳入分析。患者的憩室炎发作中位数为 5 次（四分位距 3-8），在调查实施前中位数为 2 年（四分位距 1-3）。38 名患者（29%）因憩室炎接受了择期手术。38 名患者（29%）因憩室炎接受了择期手术。38 名患者（29%）因憩室炎接受了择期手术。38 名患者（29%）因憩室炎接受了择期手术。38 名患者（29%）因憩室炎接受了择期手术。38 名患者（29%）因憩室炎接受了择期手术。决策后悔（决策后悔量表评分≥25）存在于 42 名患者（32%）中。在控制手术、性别、健康状况和治疗后年限后，决策后悔与决策冲突相关，与价值观清晰度、决策角色一致性、共享决策以及感到知情、支持和有效参与决策呈负相关（均 P<0.001）。
近三分之一的调查受访者对是否选择接受择期结肠切除术或观察治疗憩室炎的决策感到后悔。通过努力提高患者的知识、价值观清晰度、角色一致性和共享决策，可以减少决策后悔。
