Hawkins Alexander T, Rothman Russell, Geiger Timothy M, Bonnet Kemberlee R, Mutch Matthew G, Regenbogen Scott E, Schlundt David G, Penson David F
Division of General Surgery, Section of Colon & Rectal Surgery, Vanderbilt University Medical Center, Nashville, TN.
Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN.
Ann Surg Open. 2022 Jun;3(2). doi: 10.1097/as9.0000000000000157. Epub 2022 May 4.
This study employs qualitative methodology to assess surgeons' perspective on decision making in management of recurrent diverticulitis to improve patient-centered decision making.
The decision to pursue colectomy for patients with recurrent diverticulitis is nuanced. Strategies to enact broad acceptance of guidelines for surgery are hindered because of a knowledge gap in understanding surgeons' current attitudes and opinions.
We performed semi-structured interviews with board-certified North American general and colorectal surgeons who manage recurrent diverticulitis. We purposely sampled specialists by both surgeon and practice factors. An iterative inductive/deductive strategy was used to code and analyze the interviews and create a conceptual framework.
25 surgeons were enrolled over a nine-month period. There was diversity in surgeons' gender, age, experience, training, specialty (colorectal vs general surgery) and geography. Surgeons described the difficult process to determine who receives an operation. We identified seven major themes as well as twenty subthemes of the decision-making process. These were organized into a conceptual model. Across the spectrum of interviews, it was notable that there was a move over time from decisions based on counting episodes of diverticulitis to a focus on improving quality of life. Surgeons also felt that quality of life was more dependent on psychosocial factors than the degree of physiological dysfunction. [What about what surprised you/].
Surgeons mostly have discarded older dogma in recommending colectomy for recurrent diverticulitis based on number and severity of episodes. Instead, decision making in recurrent diverticulitis is complex, involving multiple surgeon and patient factors and evolving over time. Surgeons struggle with this decision and education- or communication-based interventions that focus on shared decision making warrant development.
本研究采用定性方法评估外科医生对复发性憩室炎治疗决策的看法，以改善以患者为中心的决策。
对于复发性憩室炎患者，实施结肠切除术的决策较为微妙。由于在理解外科医生当前态度和意见方面存在知识差距，阻碍了广泛接受手术指南的策略。
我们对管理复发性憩室炎的北美认证普通外科和结直肠外科医生进行了半结构化访谈。我们根据外科医生和实践因素有目的地抽取专家样本。采用迭代归纳/演绎策略对访谈进行编码和分析，并创建一个概念框架。
在九个月的时间里招募了25名外科医生。外科医生在性别、年龄、经验、培训、专业（结直肠外科与普通外科）和地理位置方面存在差异。外科医生描述了确定哪些患者接受手术的艰难过程。我们确定了决策过程的七个主要主题以及二十个子主题。这些被组织成一个概念模型。在所有访谈中，值得注意的是，随着时间的推移，决策从基于憩室炎发作次数的计数转向了对改善生活质量的关注。外科医生还认为，生活质量更多地取决于心理社会因素，而非生理功能障碍的程度。
外科医生在基于发作次数和严重程度为复发性憩室炎推荐结肠切除术时，大多已摒弃了旧有的教条。相反，复发性憩室炎的决策很复杂，涉及多个外科医生和患者因素，并随时间演变。外科医生在这个决策上存在困难，基于共享决策的教育或沟通干预措施值得开发。
