Influencing factors in surgical decision-making: a qualitative analysis of colorectal surgeons' experiences of postoperative complications.
adverse events
colorectal surgery
complications
decision-making
non-technical skills
Journal
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland
ISSN: 1463-1318
Titre abrégé: Colorectal Dis
Pays: England
ID NLM: 100883611
Informations de publication
Date de publication:
14 Mar 2024
14 Mar 2024
Historique:
revised:
25
01
2024
received:
06
06
2023
accepted:
21
02
2024
medline:
15
3
2024
pubmed:
15
3
2024
entrez:
14
3
2024
Statut:
aheadofprint
Résumé
When making anastomotic decisions in rectal cancer surgery, surgeons must consider the risk of anastomotic leakage, which bears implications for the patient's quality of life, cancer recurrence and, potentially, death. The aim of this study was to investigate the views of colorectal surgeons on how their individual attributes (e.g. experience, personality traits) may influence their decision-making and experience of complications. This qualitative study used individual interviews for data collection. Purposive sampling was used to invite certified UK-based colorectal surgeons to participate. Participants were recruited until ongoing data review indicated no new codes were generated, suggesting data sufficiency. Data were analysed thematically following Braun and Clarke's six-step framework. Seventeen colorectal surgeons (eight female, nine male) participated. Two key themes with relevant subthemes were identified: (1) personal attributes influencing variation in decision-making (e.g. demographics, personality) and (2) the influence of complications on decision-making. Surgeons described variation in the management of complications based upon their personal attributes, which included factors such as gender, experience and subspeciality interests. Surgeons described the detrimental impact of anastomotic leakage on their mental and physical health. Experience of anastomotic leakage influences future decision-making and is associated with changes in practice even when a technical error is not identified. Colorectal surgeons consider anastomotic leaks to be personal 'failures', which has a negative impact on surgeon welfare. Better understanding of how surgeons make difficult decisions, and how surgeons respond to and learn from complications, is necessary to identify 'personalized' methods of supporting surgeons at all career stages, which may improve patient outcomes.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Bowel Research UK
Organisme : Ileostomy and Internal Pouch Association
Informations de copyright
© 2024 The Authors. Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.
Références
Frye J, Bokey EL, Chapuis PH, Sinclair G, Dent OF. Anastomotic leakage after resection of colorectal cancer generates prodigious use of hospital resources. Colorectal Dis. 2009;11(9):917-920.
McArdle CS, McMillan DC, Hole DJ. Impact of anastomotic leakage on long-term survival of patients undergoing curative resection for colorectal cancer. J Br Surg. 2005;92(9):1150-1154.
Mirnezami A, Mirnezami R, Chandrakumaran K, Sasapu K, Sagar P, Finan P. Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg. 2011;253(5):890-899.
Nesbakken A, Nygaard K, Lunde OC. Outcome and late functional results after anastomotic leakage following mesorectal excision for rectal cancer. J Br Surg. 2001;88(3):400-404.
Hayden DM, Pinzon MC, Francescatti AB, Saclarides TJ. Patient factors may predict anastomotic complications after rectal cancer surgery: anastomotic complications in rectal cancer. Ann Med Surg. 2015;4(1):11-16.
Matthiessen P, Hallböök O, Andersson M, Rutegård J, Sjödahl R. Risk factors for anastomotic leakage after anterior resection of the rectum. Colorectal Dis. 2004;6(6):462-469.
2017 European Society of Coloproctology (ESCP) Collaborating Group, Glasbey JC, Blanco-Colino R, Kelly M, Singh B, Bhangu A, et al. Association of mechanical bowel preparation with oral antibiotics and anastomotic leak following left sided colorectal resection: an international, multi-centre, prospective audit. Colorectal Dis. 2018;20:15-32.
Ito M, Sugito M, Kobayashi A, Nishizawa Y, Tsunoda Y, Saito N. Relationship between multiple numbers of stapler firings during rectal division and anastomotic leakage after laparoscopic rectal resection. Int J Colorectal Dis. 2008;23(7):703-707.
Borowski DW, Bradburn DM, Mills SJ, Bharathan B, Wilson RG, Ratcliffe AA, et al. Volume-outcome analysis of colorectal cancer-related outcomes. J Br Surg. 2010;97(9):1416-1430.
MacDermid E, Young CJ, Moug SJ, Anderson RG, Shepherd HL. Heuristics and bias in rectal surgery. Int J Colorectal Dis. 2017;32(8):1109-1115.
Moug SJ, Henderson N, Tiernan J, Bisset CN, Ferguson E, Harji D, et al. The colorectal surgeon's personality may influence the rectal anastomotic decision. Colorectal Dis. 2018;20(11):970-980.
Wallis CJ, Jerath A, Coburn N, Klaassen Z, Luckenbaugh AN, Magee DE, et al. Association of surgeon-patient sex concordance with postoperative outcomes. JAMA Surg. 2022;157(2):146-156.
Lau ES, Hayes SN, Volgman AS, Lindley K, Pepine CJ, Wood MJ. American College of Cardiology Cardiovascular Disease in women section. Does patient-physician gender concordance influence patient perceptions or outcomes? J Am Coll Cardiol. 2021;77(8):1135-1138.
Tsugawa Y, Jena AB, Figueroa JF, Orav EJ, Blumenthal DM, Jha AK. Comparison of hospital mortality and readmission rates for Medicare patients treated by male vs female physicians. JAMA Intern Med. 2017;177(2):206-213.
Bisset CN, Ferguson E, MacDermid E, Stein SL, Yassin N, Dames N, et al. Moug SJ on behalf of the Plato project steering group collaborators. Exploring variation in surgical practice: does surgeon personality influence anastomotic decision-making? Br J Surg. 2022;109(11):1156-1163.
Pinto A, Faiz O, Bicknell C, Vincent C. Surgical complications and their implications for surgeons' well-being. J Br Surg. 2013;100(13):1748-1755.
Pinto A, Faiz O, Bicknell C, Vincent C. Acute traumatic stress among surgeons after major surgical complications. Am J Surg. 2014;208(4):642-647.
Wu AW, Shapiro J, Harrison R, Scott SD, Connors C, Kenney L, et al. The impact of adverse events on clinicians: what's in a name? J Patient Saf. 2020;16(1):65-72.
Han K, Bohnen JD, Peponis T, Martinez M, Nandan A, Yeh DD, et al. The surgeon as the second victim? Results of the Boston intraoperative adverse events Surgeons' attitude (BISA) study. J Am Coll Surg. 2017;224(6):1048-1056.
Bisset CN, Dames N, Oliphant R, Alasadi A, Anderson D, Parson S, et al. Exploring shared surgical decision-making from the patient's perspective: is the personality of the surgeon important? Colorectal Dis. 2020;22(12):2214-2221.
Casali G, Cullen W, Lock G. The rise of human factors: optimising performance of individuals and teams to improve patients' outcomes. J Thoracic Dis. 2019;11(Suppl 7):S998-S1008.
Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349-357.
Backman R, Foy R, Michael BD, Defres S, Kneen R, Solomon T. The development of an intervention to promote adherence to national guidelines for suspected viral encephalitis. Implement Sci. 2015;10(1):1-2.
Atkins L, Francis J, Islam R, O'Connor D, Patey A, Ivers N, et al. A guide to using the theoretical domains framework of behaviour change to investigate implementation problems. Implement Sci. 2017;12(1):1-8.
Etikan I, Musa SA, Alkassim RS. Comparison of convenience sampling and purposive sampling. Am J Theor Appl Stat. 2016;5(1):1-4.
Moran B, Cunningham C, Singh T, Sagar P, Bradbury J, Geh I, et al. Association of Coloproctology of Great Britain & Ireland (ACPGBI): guidelines for the management of cancer of the colon, rectum and anus (2017) - surgical management. Colorectal Dis. 2017;19:18-36.
National Bowel Cancer Audit. Annual Report. 2022 Last accessed January 2023 via: https://www.nboca.org.uk/reports/annual-report-2022/
Malterud K, Siersma VD, Guassora AD. Sample size in qualitative interview studies: guided by information power. Qual Health Res. 2016;26(13):1753-1760.
LaDonna KA, Artino AR Jr, Balmer DF. Beyond the guise of saturation: rigor and qualitative interview data. J Grad Med Educ. 2021;13(5):607-611.
Braun V, Clarke V. One size fits all? What counts as quality practice in (reflexive) thematic analysis? Qual Res Psychol. 2021;18(3):328-352.
Biggs S, Waggett HB, Shabbir J. Impact of surgical complications on the operating surgeon. Colorectal Dis. 2020;22(9):1169-1174.
Vallance AE, Fearnhead NS, Kuryba A, Hill J, Maxwell-Armstrong C, Braun M, et al. Effect of public reporting of surgeons' outcomes on patient selection, “gaming,” and mortality in colorectal cancer surgery in England: population based cohort study. BMJ. 2018;2:361.
Radford PD, Derbyshire LF, Shalhoub J, Fitzgerald JE. Council of the Association of surgeons in training. Publication of surgeon specific outcome data: a review of implementation, controversies and the potential impact on surgical training. Int J Surg. 2015;13:211-216.
Luu S, Patel P, St-Martin L, Leung AS, Regehr G, Murnaghan ML, et al. Waking up the next morning: surgeons' emotional reactions to adverse events. Med Educ. 2012;46(12):1179-1188.
Sinitsky DM, Gowda SB, Dawas K, Fernando BS. Morbidity and mortality meetings to improve patient safety: a survey of 109 consultant surgeons in London. United Kingdom. Patient Saf Surg. 2019;13(1):1-7.
Pepper JR, Jaggar SI, Mason MJ, Finney SJ, Dusmet M. Schwartz rounds: reviving compassion in modern healthcare. J R Soc Med. 2012;105(3):94-95.
Brennan PA, Mitchell DA, Holmes S, Plint S, Parry D. Good people who try their best can have problems: recognition of human factors and how to minimise error. Br J Oral Maxillofac Surg. 2016;54(1):3-7.
Querstret D, Cropley M. Assessing treatments used to reduce rumination and/or worry: a systematic review. Clin Psychol Rev. 2013;33(8):996-1009.
Payne N, Kinman G. Job demands, resources and work-related well-being in UK firefighters. Occup Med. 2019;69(8-9):604-609.
Esmail A, Everington S. GMC needs to take a more proactive role in preventing harm and suicide in doctors under investigation. BMJ. 2022;379:o2883.
Specht J, Egloff B, Schmukle SC. Stability and change of personality across the life course: the impact of age and major life events on mean-level and rank-order stability of the big five. J Pers Soc Psychol. 2011;101(4):862--82.
Baigrie RJ, Stupart D. Coping with anastomotic leaks: harder as one gets older? Br J Surg. 2023;110:395-396.
Edrees H, Connors C, Paine L, Norvell M, Taylor H, Wu AW. Implementing the RISE second victim support programme at the Johns Hopkins Hospital: a case study. BMJ Open. 2016;6(9):e011708.
Royal College of Surgeons of England. Supporting surgeons after adverse events: Good Practice Guide. 2020 Last accessed January 2023 via: https://www.rcseng.ac.uk/standards-and-research/standards-and-guidance/good-practice-guides/supporting-surgeons-after-adverse-events/
Johal HK, Prout R, Birchley G, Huxtable R. We should move away from a focus on individual resilience towards building resilient systems. BMJ. 2021;375:n2737.
Vitous CA, Ivatury SJ, Suwanabol PA. Value of qualitative research in colorectal surgery. Dis Colon Rectum. 2021;64(12):1444-1446.