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How surgeons make decisions when the evidence is inconclusive

Hageman, Michiel G.J.S., Guitton, Thierry G., Ring, David, Osterman, A. Lee, Spoor, A.B., van der Zwan, A.L., Shrivastava, Abhay, Wahegaonkar, Abhijeet L., Garcia G., Aida E., Aita, M.A., Castillo, Alberto Perez, Marcus, Alexander, Ladd, Amy, Terrono, Andrew L., Gutow, Andrew P., Schmidt, Andrew, Wang, Angela A., Eschler, Anica, Miller, Anna N., Wikeroy, Annette K.B., Barquet, Antonio, Armstrong, April D., van Vugt, Arie B., Page, Richard S. and Science of Variation Group 2013, How surgeons make decisions when the evidence is inconclusive, Journal of hand surgery, vol. 38, no. 6, pp. 1202-1208, doi: 10.1016/j.jhsa.2013.02.032.

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Title How surgeons make decisions when the evidence is inconclusive
Author(s) Hageman, Michiel G.J.S.
Guitton, Thierry G.
Ring, David
Osterman, A. Lee
Spoor, A.B.
van der Zwan, A.L.
Shrivastava, Abhay
Wahegaonkar, Abhijeet L.
Garcia G., Aida E.
Aita, M.A.
Castillo, Alberto Perez
Marcus, Alexander
Ladd, Amy
Terrono, Andrew L.
Gutow, Andrew P.
Schmidt, Andrew
Wang, Angela A.
Eschler, Anica
Miller, Anna N.
Wikeroy, Annette K.B.
Barquet, Antonio
Armstrong, April D.
van Vugt, Arie B.
Page, Richard S.ORCID iD for Page, Richard S. orcid.org/0000-0002-2225-7144
Science of Variation Group
Journal name Journal of hand surgery
Volume number 38
Issue number 6
Start page 1202
End page 1208
Total pages 7
Publisher Elsevier
Place of publication Maryland Heights, Mo.
Publication date 2013-06
ISSN 0363-5023
1531-6564
Keyword(s) decision making
evidence-based medicine
treatment
Clinical Competence
Female
Hand
Humans
Male
Mentors
Orthopedics
Practice Guidelines as Topic
Science of Variation Group
Summary 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.
Language eng
DOI 10.1016/j.jhsa.2013.02.032
Field of Research 110399 Clinical Sciences not elsewhere classified
1103 Clinical Sciences
Socio Economic Objective 970111 Expanding Knowledge in the Medical and Health Sciences
HERDC Research category C1.1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2013, American Society for Surgery of the Hand
Persistent URL http://hdl.handle.net/10536/DRO/DU:30087931

Document type: Journal Article
Collections: Faculty of Health
School of Medicine
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