Problem addressed, background and strategic significance
There is huge variability in whether patients get a stoma (bag) after rectal surgery. We have known that surgeon decision making is influenced by patient factors, such as whether the patient had pre-operative treatment and height from the anus of the cancer, as these factors may influence likelihood of a leak from a join. However, we are increasingly acknowledging that these individual patient based clinical decisions are also influenced by individual surgeon personality, personal and institutional factors. Publication of individual surgeon outcomes may affect clinical practice, especially when these results are in the public domain. It is important that we start to acknowledge and understand how provision of this information to the public may cause changes in clinical practice. This study will explore how personal, social and institutional factors affect surgeon decision making. The aim of this study is to build a theory of how surgeons attribute importance and weigh up these different factors within the context and institutions in which they work.
This study will use a grounded theory method, gathering data through one to one qualitative interview with surgeons.
Hoped for results of this research
It is hoped that the research will explain how clinical decisions may be affected by publication of surgeon outcome data. We aim to build a theory of how surgeons weigh up different factors within the decision making process prior to deciding whether an individual patient gets a join in the bowel or a bag.
How will this project help build on the Delphi question and what further plans are proposed for future development?
This research is novel because it starts to make links between two important Delphi questions – linking surgeon decision making around making an anastomosis with research around how publication of surgeon outcomes may affect clinical practice. This project builds upon the themes that emerged from the Edinburgh Delphi process and allows detailed exploration of context and circumstances with individual surgeons.