A qualitative study on surgeon perceptions of risk calculators in emergency general surgery

OBJECTIVE: To understand how surgeons perceive risk calculators in emergency general surgery (EGS).

BACKGROUND: EGS involves complex decision-making of operative and nonoperative management. Risk calculators can aid in shared decision-making and informed consent.

METHODS: We performed semi-structured interviews among emergency surgeons within 1 healthcare system to explore perceptions of risk calculators in EGS. Interviews were completed until thematic saturation, transcribed, coded in duplicate, and analyzed using inductive analysis within a modified grounded theory framework to generate theory regarding surgeon perceptions of risk calculators in EGS.

RESULTS: Among 20 interviewees, the mean age was 45. We identified dominant themes related to the concerns of and benefits of using risk calculators within EGS, both in situations of clear and unclear best treatment options. Surgeons questioned risk calculator validity and noted that a lack of health numeracy can limit their use. Risk calculators were seen as helpful for communication, consensus building, informed consent, and litigation mitigation. The ideal risk calculator should have low activation energy for use, incorporate relevant data and accurate prognostication, and provide actionable, easily interpretable output. Education for providers and patients on risk calculator availability and use is necessary.

CONCLUSIONS: Although surgeons may initially question the data produced by risk calculators in EGS, they identify several potential virtues to their bedside use when optimal treatment options are and are not clear. The ideal risk calculator for use in EGS should be convenient and relevant. Future studies are needed to explore patient perceptions and to directly observe patterns of risk calculator use.

National Institute on Aging

Claire B Rosen, Amanda L Bader, Sanford E Roberts, Justin T Clapp, Scott D Halpern, Margaret L Schwarze, Rachel R Kelz