Influencing factors in surgical decision-making: a qualitative analysis of colorectal surgeons' experiences of postoperative complications

Carly N Bisset; Susan J Moug; Raymond Oliphant; Nicola Dames; Simon Parson; Jennifer Cleland

doi:10.1111/codi.16943

Influencing factors in surgical decision-making: a qualitative analysis of colorectal surgeons' experiences of postoperative complications

Carly N Bisset^* (Corresponding Author), Susan J Moug, Raymond Oliphant, Nicola Dames, Simon Parson, Jennifer Cleland

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

AIM: 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.

METHOD: 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.

RESULTS: 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.

CONCLUSION: 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.

Original language	English
Number of pages	7
Journal	Colorectal Disease
Early online date	14 Mar 2024
DOIs	https://doi.org/10.1111/codi.16943
Publication status	E-pub ahead of print - 14 Mar 2024

Bibliographical note

Open Access via the Wiley Agreement

This work was kindly supported by Bowel Research UK and the Ileostomy and Internal Pouch Association. The funders had no influence in the design, delivery or interpretation of this study.

Data Availability Statement

Data sharing not applicable to this article as no datasets were gener-ated or analysed during the current study.

Keywords

adverse events
colorectal surger
complications
decision-making
non-technical skills

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1111/codi.16943Licence: CC BY

Cite this

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title = "Influencing factors in surgical decision-making: a qualitative analysis of colorectal surgeons' experiences of postoperative complications",

abstract = "AIM: 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.METHOD: 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.RESULTS: 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.CONCLUSION: 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.",

keywords = "adverse events, colorectal surger, complications, decision-making, non-technical skills",

author = "Bisset, {Carly N} and Moug, {Susan J} and Raymond Oliphant and Nicola Dames and Simon Parson and Jennifer Cleland",

note = "Open Access via the Wiley Agreement This work was kindly supported by Bowel Research UK and the Ileostomy and Internal Pouch Association. The funders had no influence in the design, delivery or interpretation of this study.",

year = "2024",

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doi = "10.1111/codi.16943",

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T2 - a qualitative analysis of colorectal surgeons' experiences of postoperative complications

AU - Bisset, Carly N

AU - Moug, Susan J

AU - Oliphant, Raymond

AU - Dames, Nicola

AU - Parson, Simon

AU - Cleland, Jennifer

N1 - Open Access via the Wiley Agreement This work was kindly supported by Bowel Research UK and the Ileostomy and Internal Pouch Association. The funders had no influence in the design, delivery or interpretation of this study.

PY - 2024/3/14

Y1 - 2024/3/14

N2 - AIM: 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.METHOD: 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.RESULTS: 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.CONCLUSION: 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.

AB - AIM: 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.METHOD: 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.RESULTS: 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.CONCLUSION: 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.

KW - adverse events

KW - colorectal surger

KW - complications

KW - decision-making

KW - non-technical skills

U2 - 10.1111/codi.16943

DO - 10.1111/codi.16943

M3 - Article

C2 - 38485203

SN - 1462-8910

JO - Colorectal Disease

JF - Colorectal Disease

ER -

Influencing factors in surgical decision-making: a qualitative analysis of colorectal surgeons' experiences of postoperative complications

Abstract

Bibliographical note

Data Availability Statement

Keywords

UN SDGs

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