Daniels, S.L. orcid.org/0000-0001-9452-3344, Morgan, J., Lee, M.J. orcid.org/0000-0001-9971-1635 et al. (5 more authors) (2023) Surgeon preference for treatment allocation in older people facing major gastrointestinal surgery : an application of the discrete choice experiment methodology. Colorectal Disease, 25 (1). pp. 102-110. ISSN 1462-8910
Abstract
Aim
Variation in major gastrointestinal surgery rates in the older population suggests heterogeneity in surgical management. A higher prevalence of co-morbidities, frailty and cognitive impairments in the older population may account for some variation. The aim of this study was to determine surgeon preference for major surgery versus conservative management in hypothetical patient scenarios based on key attributes.
Method
A survey was designed according to the discrete choice methodology guided by a separate qualitative study. Questions were designed to test for associations between key attributes (age, co-morbidity, urgency of presentation, pathology, functional and cognitive status) and treatment preference for major gastrointestinal surgery versus conservative management. The survey consisting of 18 hypothetical scenarios was disseminated electronically to UK gastrointestinal surgeons. Binomial logistic regression was used to identify associations between the attributes and treatment preference.
Results
In total, 103 responses were received after 256 visits to the questionnaire site (response rate 40.2%). Participants answered 1,847 out of the 1,854 scenarios (99.6%). There was a preference for major surgery in 1112/1847 (60.2%) of all scenarios. Severe co-morbidities (OR 0.001; 95% CI 0.000 – 0.030, p=0.000), severe cognitive impairment (OR 0.001; 95% CI 0.000 – 0.033, p=0.000) and age 85 years and above (OR 0.028; 95% CI 0.005 – 0.168, p=0.000) were all significant in the decision not to offer major GI surgery.
Conclusion
This study has demonstrated variation in surgical treatment preference according to key attributes in hypothetical scenarios. The development of fitness-stratified guidelines may help to reduce variation in surgical practice in the older population.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2022 The Authors. Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes (http://creativecommons.org/licenses/by-nc/4.0/). |
Keywords: | Surgery; Older adults; Gastrointestinal surgery; Clinical practice variation |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 31 Aug 2022 10:25 |
Last Modified: | 25 Sep 2024 11:51 |
Status: | Published |
Publisher: | Wiley |
Refereed: | Yes |
Identification Number: | 10.1111/codi.16296 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:190474 |