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World Journal of Surgery

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01-04-2021 | Original Scientific Report

If in Doubt Don’t Act Out! Exploring Behaviours in Clinical Decision Making by General Surgeons Towards Surgical Procedures

Authors: Dale F. Whelehan, Kevin C. Conlon, Paul F. Ridgway

Published in: World Journal of Surgery | Issue 4/2021

Abstract

Background

Clinical decision-making (CDM) plays an integral role to surgeons work and has ramifications for patient outcomes and experience. The factors influencing a surgeons decision-making and the utility of cognitive decisional short cuts used in CDM known as ‘heuristics’ remains unknown. The aim of this paper is to explore how general surgeons make decisions in high-stake biliary tract clinical scenarios.

Methods

This was a cross sectional survey comprising of two sections—a ‘demographics section’ and a ‘clinical vignettes section’. Participants were recruited by an email distributed by the Royal College of Surgeons in Ireland. Non-parametric testing examined relationships and content analysis was applied for clinical reasoning.

Results

73 participants or 37.6% of the overall population completed the survey. 71.4% of these were male. Most (50%) were higher trainees with moderate levels of overall reflective practice in decision-making. A majority of participants chose conservatively in high-stake biliary tract clinical cases with disease factors (43.5%) weighted highest, followed by personal factors (41.1%) and patient factors (15.4%) in clinical reasoning. The presence of a ‘hook’ associated with commonly used heuristics did not significantly change decision-making behaviour.

Conclusion

In high-stake scenarios, surgeons make conservative clinical decisions, predominantly dominated by disease and personal justifications. The utility of heuristics in lower-stake scenarios should be explored regarding clinical decision-making rationale and outcomes. Practitioners should consider use of patient factors in high-stake decisions to enable shared decision-making when appropriate which can reduce post-decisional regret and support the vision of patient-centred care.

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Title: If in Doubt Don’t Act Out! Exploring Behaviours in Clinical Decision Making by General Surgeons Towards Surgical Procedures
Authors: Dale F. Whelehan
Kevin C. Conlon
Paul F. Ridgway
Publication date: 01-04-2021
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 4/2021
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-020-05888-2

At a glance: The STEP trials

Springer Medicine

If in Doubt Don’t Act Out! Exploring Behaviours in Clinical Decision Making by General Surgeons Towards Surgical Procedures

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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