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The Use and Impact of a Decision Support Tool for Appendicitis Treatment.
Rosen, Joshua E; Monsell, Sarah E; DePaoli, Sara C; Fannon, Erin C; Kohler, Johnathan E; Reinke, Caroline E; Kao, Lillian S; Fransman, Ryan B; Stulberg, Jonah J; Shapiro, Michael B; Nehra, Deepika; Park, Pauline K; Sanchez, Sabrina E; Fischkoff, Katherine N; Davidson, Giana H; Flum, David R.
Afiliación
  • Rosen JE; Department of Surgery, University of Washington, Seattle, WA.
  • Monsell SE; Department of Biostatistics, University of Washington, Seattle, WA.
  • DePaoli SC; Department of Surgery, University of Washington, Seattle, WA.
  • Fannon EC; Department of Surgery, University of Washington, Seattle, WA.
  • Kohler JE; University of California, Davis, UC Davis Children's Hospital, Sacramento, CA.
  • Reinke CE; Atrium Health, Charlotte, NC.
  • Kao LS; UTHealth Houston, Houston, TX.
  • Fransman RB; Grady Health Center/Morehouse School of Medicine, SE, Atlanta, Georgia.
  • Stulberg JJ; Lyndon B Johnson Hospital, Houston, TX.
  • Shapiro MB; Northwestern Medicine, Chicago, IL.
  • Nehra D; Department of Surgery, Harborview Medical Center, University of Washington, Seattle WA.
  • Park PK; Michigan Medicine, Ann Arbor, MI.
  • Sanchez SE; Boston Medical Center, Boston, MA.
  • Fischkoff KN; Columbia University Medical Center, Columbia University Medical Center Research Office, New York, NY.
  • Davidson GH; Department of Surgery, University of Washington, SORCE, Seattle, WA.
  • Flum DR; Department of Surgery, University of Washington, Seattle, WA.
Ann Surg ; 280(4): 616-622, 2024 Oct 01.
Article en En | MEDLINE | ID: mdl-38916104
ABSTRACT

OBJECTIVE:

Since introducing new and alternative treatment options may increase decisional conflict, we aimed to describe the use of the decision support tool (DST) and its impact on treatment preference and decisional conflict.

BACKGROUND:

For the treatment of appendicitis, antibiotics are an effective alternative to appendectomy, with both approaches associated with a different set of risks (eg, recurrence vs surgical complications) and benefits (eg, more rapid return to work vs decreased chance of readmission). Patients often have limited knowledge of these treatment options, and DSTs that include video-based educational materials and questions to elicit patient preferences about outcomes may be helpful. Concurrent with the Comparing Outcomes of Drugs and Appendectomy trials, our group developed a DST for appendicitis treatment ( www.appyornot.org ).

METHODS:

A retrospective cohort including people who self-reported current appendicitis and used the AppyOrNot DST between 2021 and 2023. Treatment preferences before and after the use of the DST, demographic information, and Ottawa Decisional Conflict Scale (DCS) were reported after completing the DST.

RESULTS:

A total of 8243 people from 66 countries and all 50 U.S. states accessed the DST. Before the DST, 14% had a strong preference for antibiotics and 31% for appendectomy, with 55% undecided. After using the DST, the proportion in the undecided category decreased to 49% ( P < 0.0001). Of those who completed the Ottawa Decisional Conflict Score (DCS; n = 356), 52% reported the lowest level of decisional conflict (<25) after using the DST; 43% had a DCS score of 25 to 50, 5.1% had a DCS score of >50 and 2.5% had and DCS score of >75.

CONCLUSIONS:

The publicly available DST appyornot.org reduced the proportion that was undecided about which treatment they favored and had a modest influence on those with strong treatment preferences. Decisional conflict was not common after use. The use of this DST is now a component of a nationwide implementation program aimed at improving the way surgeons share information about appendicitis treatment options. If its use can be successfully implemented, this may be a model for improving communication about treatment for patients experiencing emergency health conditions.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Apendicectomía / Apendicitis / Técnicas de Apoyo para la Decisión / Prioridad del Paciente Límite: Adolescent / Adult / Female / Humans / Male / Middle aged Idioma: En Revista: Ann Surg Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Apendicectomía / Apendicitis / Técnicas de Apoyo para la Decisión / Prioridad del Paciente Límite: Adolescent / Adult / Female / Humans / Male / Middle aged Idioma: En Revista: Ann Surg Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos