Patient Preferences Between Surgical and Medical Treatment in Crohn's Disease

Byrne, Christopher; Solomon, Michael J.; Young, Jane; Selby, Warwick; Harrison, James D.

doi:10.1007/s10350-006-0847-0

Cited by 45 publications

(52 citation statements)

References 43 publications

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“…This was based on a validated prospective measure of preference method described in previous trials. [26][27][28] The questionnaire also elicited demographic data, type of antenatal care, obstetric history (miscarriages, ectopics and terminations) and the mode of delivery the pregnant woman planned to have if her pregnancy was uncomplicated. Questions pertaining to the willingness of pregnant women to be involved in a hypothetical randomised controlled trial (RCT) of VD versus elective caesarean section were also asked but will be reported separately.…”

Section: Development Of Questionnaire For Pregnant Womenmentioning

confidence: 99%

Vaginal delivery compared with elective caesarean section: the views of pregnant women and clinicians

Turner

Young

Solomon

et al. 2008

BJOG

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Objective To quantify the risk of morbidity from vaginal delivery (VD) that pregnant women would be prepared to accept before requesting an elective caesarean section and to compare these views with those of clinicians.Design Cross-sectional survey.Setting Major teaching hospital (nulliparas and midwives) and national samples of medical specialists.Sample Nulliparas (n = 122), midwives (n = 84), obstetricians (n = 166), urogynaecologists (n = 12) and colorectal surgeons (n = 79).Methods Face-to-face interviews (nulliparas) and mailed questionnaire (clinicians).Main outcome measures Maximum level of risk participants would be prepared to accept before opting for an elective caesarean section for each of 17 potential complications of VD. Utility scores for each complication were calculated with higher scores (closer to 1) indicating a greater acceptance of risk.Results Pregnant women were willing to accept higher risks than clinicians for all 17 potential complications. They were least accepting of the risks of severe anal incontinence (mean utility score 0.32), emergency caesarean section (0.51), moderate anal incontinence (0.56), severe urinary incontinence (0.56), fourth-degree tears (0.59) and third-degree tears (0.72). The views of midwives were closest to those of pregnant women. Urogynaecologists and colorectal surgeons were the most risk averse, with 42 and 41%, respectively, stating that they would request an elective caesarean for themselves or their partners.Conclusions Pregnant women were willing to accept significantly higher risks of potential complications of VD than clinicians involved in their care. Pregnant women's views were more closely aligned to midwives than to medical specialists.

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Section: Development Of Questionnaire For Pregnant Womenmentioning

confidence: 99%

Vaginal delivery compared with elective caesarean section: the views of pregnant women and clinicians

Turner

Young

Solomon

et al. 2008

BJOG

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“…Clinicians are known to favor interventions with which they are most familiar, or most skilled at in their routine practice. 4,12,13 It was interesting to note that we found several respondents were unable to consider participation in the trial because they lacked the surgical training or experience to be able to offer both procedures. This acknowledged differential surgical expertise provides an argument in favor of revisiting expertise-based randomized trials for surgical research in the future.…”

Section: Discussionmentioning

confidence: 94%

Clinicians' views on the feasibility of surgical randomized trials in urogynecology: Results of a questionnaire survey

Bakali

Pitchforth

Tincello

et al. 2010

Neurourology and Urodynamics

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This study highlights the difference between collective and individual equipoise and their impact upon surgical trials. Clinicians held strong views preventing them from regarding the study favorably. Difficulty with relinquishing control over choice of procedure appeared central. These findings support the growing evidence in favor of detailed qualitative pilot work for surgical trials. The role of expertise-based randomization deserves further consideration.

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“…None of the sources in the study described life after surgery in much depth, perhaps due to the fact the majority of sources were uploaded by the healthcare industry. This is not a surprise as it has been shown that clinician preferences are different from those of their patients [36]. There is concern that online health information may be misleading [37].…”

mentioning

confidence: 99%

“…There is concern about information overload confusing patients and clouding their judgment when making treatment choices. [38,39] The principal concept of SDM is a joint decision made by a clinician and an informed patient and does not involve the internet [17,18,36,40].…”

mentioning

confidence: 99%

Assessing Internet Based Information Used to Aid Patient Decision Making in Surgery for Perianal Crohn's Fistula

Marshall

Baker

Lee

et al. 2017

International Journal of Surgery

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Background Decision-making in perianal Crohn's fistula (pCD) is preference sensitive. Patients use the internet to access healthcare information. The aim of this study was to assess the online information and patient decision aids relating to surgery for pCD. Methods A search of Google TM and the Decision Aids Library Inventory (DALI) was performed using a predefined search strategy. Patient-focussed sources providing information about pCD surgery were included in the analysis. Written health information was assessed using the International Patient Decision Aids Standards (IPDAS) and DISCERN criteria. The readability of the source content was assessed using the Flesch-Kincaid score. Results Of the 201 sources found, 187 were excluded, leaving 14 sources for analysis. Three sources were dedicated to pCD, and six sources mentioned pCD-specific outcomes. The most common surgical intervention reported was seton insertion (n = 13). The least common surgical intervention reported was proctectomy (n = 1). The mean IPDAS and DISCERN scores were 4.43 ± 1.65 out of 12 (range = 2-8) and 2.93 ± 0.73 out of 5 (range = 1-5), respectively. The mean reading ease was US college standard. Conclusions We found no patient decision aids relating to surgery for pCD. The online sources relating to surgery for pCD are few, and their quality is poor, as seen in the low IPDAS and DISCERN scores. Less than half of the sources mentioned pCD-specific outcomes, and three sources were solely dedicated to providing information on pCD. Healthcare professionals should look to create a patient tool to assist decision-making in pCD.

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Patient Preferences Between Surgical and Medical Treatment in Crohn's Disease

Cited by 45 publications

References 43 publications

Vaginal delivery compared with elective caesarean section: the views of pregnant women and clinicians

Vaginal delivery compared with elective caesarean section: the views of pregnant women and clinicians

Clinicians' views on the feasibility of surgical randomized trials in urogynecology: Results of a questionnaire survey

Assessing Internet Based Information Used to Aid Patient Decision Making in Surgery for Perianal Crohn's Fistula

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