How surgeons make decisions when the evidence is inconclusive

Michiel G J S Hageman, Thierry G. Guitton, David Ring, A. Lee Osterman, A. B. Spoor, A. L. Van Der Zwan, Abhay Shrivastava, Abhijeet L. Wahegaonkar, Aida E G Garcia, M. A. Aita, Alberto Pérez Castillo, Alexander Marcus, Amy Ladd, Andrew L. Terrono, Andrew P. Gutow, Andrew Schmidt, Angela A. Wang, Anica Eschler, Anna N. Miller, Annette K B WikerøyAntonio Barquet, April D. Armstrong, Arie B. Van Vugt, Asheesh Bedi, Ashok K. Shyam, Augustus D. Mazzocca, Axel Jubel, Babst H. Reto, Betsy M. Nolan, Bob Arciero, B. Van Den, Brent Bamberger, Bret C. Peterson, Brett D. Crist, Brian J. Cross, Brian L. Badman, C. Noel Henley, Carl Ekholm, Carrie Swigart, Chad Manke, Charalampos Zalavras, Charles A. Goldfarb, Charles Cassidy, Charles Cornell, Charles L. Getz, Charles Metzger, Chris Wilson, Christian Heiss, Christian J. Perrotto, Christopher J. Wall, Christopher J. Walsh, Christos Garnavos, Chunyan Jiang, Craig Lomita, Craig M. Torosian, Daniel A. Rikli, Daniel B. Whelan, Daniel C. Wascher, Daniel Hernandez, Daniel Polatsch, Daphne Beingessner, Darren Drosdowech, David E. Tate, David Hak, David J. Rowland, David M. Kalainov, David Nelson, David Weiss, Desirae M. McKee, D. F P Van Deurzen, Donald Endrizzi, Konul Erol, Joachim P. Overbeck, Wolfgang Baer, Eckart Schwab, Edgardo Ramos Maza, Edward Harvey, Edward K. Rodriguez, Elisabeth Prelog-Igler, Emil H. Schemitsch, Eon K. Shin, Eric P. Hofmeister, F. Thomas, D. Kaplan, F. J P Beeres, Fabio Suarez, C. H. Fernandes, Fidel Ernesto, Cayón Cayón, Filip Celestyn Dolatowski, Fischmeister Martin, Francisco Javier Aguilar Sierra, Francisco Lopez-Gonzalez, Frank Walter, Franz Josef Seibert, Fred Baumgaertel, Frede Frihagen, P. C. Fuchs, Georg M. Huemer, George Kontakis, George S. Athwal, George S M Dyer, George Thomas, Georges Kohut, Gerald Williams, German Ricardo Hernandez, Gladys Cecilia Zambrano Caro, Grant Garrigues, Greg Merrell, Gregory DeSilva, Gregory J. Della Rocca, Gustavo Regazzi, Gustavo Borges Laurindo De Azevedo, Gustavo Mantovani Ruggiero, H. J. Helling, Hal MccUtchan, Hans Goost, Hans J. Kreder, Paula M. Hasenboehler, Howard D. Routman, Huub Van Der Heide, I. Kleinlugtenbelt, Iain McGraw, Ian Harris, Ibrahim Mohammad Ibrahim, Ines C. Lin, A. Iossifidis, J. Andrew I Trenholm, J. Carel Goslings, J. Michael Wiater, Jack Choueka, Jaimo Ahn, James Kellam, Jan Biert, Jay Pomerance, Jeff W. Johnson, Jeffrey A. Greenberg, Jeffrey Yao, Jeffry T. Watson, Jennifer L. Giuffre, Jeremy Hall, Jin Young Park, Jochen Fischer, Joel Murachovsky, John Howlett, John McAuliffe, John P. Evans, John Taras, Jonathan Braman, Jonathan L. Hobby, Jonathan Rosenfeld, Jorge Boretto, Jorge Orbay, Jorge Rubio, Jose A. Ortiz, Joseph Abboud, Joseph M. Conflitti, Joseph P A M Vroemen, Julie Adams, J. V. Clarke, K. Kabir, Karel Chivers, Karl Josef Prommersberger, Keith Segalman, Kendrick Lee, Kevin Eng, Kimberlly S. Chhor, K. J. Ponsen, Kyle Jeray, L. Marsh, L. M S J Poelhekke, Ladislav Mica, Lars C. Borris, Lawrence Halperin, Lawrence Weiss, Leon Benson, Leon Elmans, Leonardo Alves De Mendonca, Leonardo Rocha, Leonid Katolik, Lisa Lattanza, Lisa Taitsman, Lob Guenter, Louis Catalano, Luis Antonio Buendia, Luke S. Austin, M. Jason Palmer, M. R. De Vries, M. R. Krijnen, Maarten W G A Bronkhorst, Mahmoud I. Abdel-Ghany, M. A J Van De Sande, Marc Swiontkowski, Marco Rizzo, Marcus Lehnhardt, Marinis Pirpiris, Mark Baratz, Mark D. Lazarus, Martin Boyer, Martin Richardson, Matej Kastelec, Matt Mormino, Matthew D. Budge, Matthias Turina, Megan M. Wood, Michael Baskies, Michael Baumgaertner, Michael Behrman, Michael Hausman, Michael Jones, Michael LeCroy, Michael Moskal, Michael Nancollas, Michael Prayson, Michael W. Grafe, Michael W. Kessler, Michel P J Van Den Bekerom, Mike Mckee, Milind Merchant, Minos Tyllianakis, Naquira Escobar Luis Felipe, Neal C. Chen, Neil Saran, Neil Wilson, Nicholas L. Shortt, Niels Schep, Nigel Rossiter, N. G. Lasanianos, Nikolaos Kanakaris, Noah D. Weiss, Norah M. Harvey, P. V. Van Eerten, Parag Melvanki, Patrick T. McCulloch, Paul A. Martineau, Paul Appleton, Paul Guidera, Paul Levin, Peter Giannoudis, Peter J. Evans, Peter Jebson, Peter Kloen, Peter Krause, Peter R G Brink, J. H. Peters, Philip Blazar, Philipp N. Streubel, Porcellini, Prashanth Ina, S. Prashanth, Punita V. Solanki, Qiugen Wang, M. Quell, R. Bryan Benafield, R. Haverlag, R. W. Peters, Rajat Varma, Ralf Nyszkiewicz, Ralph M. Costanzo, Ramon De Bedout, Ashish S. Ranade, Raymond Malcolm Smith, Reid Abrams, Renato M. Fricker, Reza Omid, Richard Barth, Richard Buckley, Richard Jenkinson, Richard S. GIlbert, Richard S. Page, Richard Wallensten, Robert D. Zura, Robert J. Feibel, Robert R L Gray, Robert Tashijan, Robert Wagenmakers, Rodrigo Pesantez, Roger Van Riet, Rolf Norlin, Roman Pfeifer, Ronald Liem, Roy G. LiemKulick, Rozental, Rudolf W. Poolman, Russell Shatford, Ryan Klinefelter, Ryan P. Calfee, Sam Moghtaderi, Samir Sodha, Sander Sprujt, Sanjeev Kakar, Saul Kaplan, Schandelmaier, Scott Duncan, Sebastian Kluge, Sebastian Rodriguez-Elizalde, Sergio L. Checchia, Sergio Rowinski, Seth Dodds, Shep Hurwit, K. Sprengel, W. A H Van Der Stappen, Steve Kronlage, Steven Beldner, Steven J. McCabe, Steven J. Morgan, Steven J. Rhemrev, Stuart Hilliard, Taco Gosens, Takashi Sasaki, C. Taleb, Tamir Pritsch, Theodoros Tosounidis, Theresa Wyrick, Thomas DeCoster, Thomas Dienstknecht, Thomas G. Stackhouse, Thomas Hughes, Thomas Wright, Thuan V. Ly, Timothy G. Havenhill, Timothy Omara, Todd Siff, Toni M. McLaurin, Tony Wanich, Johannes M. Rueger, Frederico C M Vallim, Vani J. Sabesan, Vasileios S. Nikolaou, Verhofstad, Victoria D. Knoll, Vidyadhar Telang, Vishwanath M. Iyer, Vispi Jokhi, W. Arnnold Batson, W. Jaap Willems, Wade R. Smith, William Dias Belangero, J. Wolkenfelt, Yoram Weil

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Purpose To address the factors that surgeons use to decide between 2 options for treatment when the evidence is inconclusive. Methods We tested the null hypothesis that the factors surgeons use do not vary by training, demographics, and practice. A total of 337 surgeons rated the importance of 7 factors when deciding between treatment and following the natural history of the disease and 12 factors when deciding between 2 operative treatments using a 5-point Likert scale between 'very important' and 'very unimportant.' Results According to the percentages of statements rated very important or somewhat important, the most popular factors influencing recommendations when evidence is inconclusive between treatment and following the natural course of the illness were 'works in my hands,' 'familiarity with the treatment,' and 'what my mentor taught me.' The most important factors when evidence shows no difference between 2 surgeries were 'fewer complications,' 'quicker recovery,' 'burns fewer bridges,' 'works in my hands' and 'familiarity with the procedure.' Europeans rated 'works in my hands' and 'cheapest/most resourceful' of significantly greater importance and 'what others are doing,' 'highest reimbursement,' and 'shorter procedure' of significantly lower importance than surgeons in the United States. Observers with fewer than 10 years in independent practice rated 'what my mentor taught me,' 'what others are doing' and 'highest reimbursement' of significantly lower importance compared to observers with 10 or more years in independent practice. Conclusions Surgeons deciding between 2 treatment options, when the evidence is inconclusive, fall back to factors that relate to their perspective and reflect their culture and circumstances, more so than factors related to the patient's perspective, although this may be different for younger surgeons. Clinical relevance Hand surgeons might benefit from consensus fallback preferences when evidence is inconclusive. It is possible that falling back to personal comfort makes us vulnerable to unhelpful commercial and societal influences.

Original languageEnglish (US)
Pages (from-to)1202-1208
Number of pages7
JournalJournal of Hand Surgery
Volume38
Issue number6
DOIs
StatePublished - Jun 2013
Externally publishedYes

Fingerprint

Hand
Mentors
Therapeutics
Surgeons
Consensus
Demography
Recognition (Psychology)

Keywords

  • Decision making
  • Evidence-based medicine
  • Treatment

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery

Cite this

Hageman, M. G. J. S., Guitton, T. G., Ring, D., Lee Osterman, A., Spoor, A. B., Van Der Zwan, A. L., ... Weil, Y. (2013). How surgeons make decisions when the evidence is inconclusive. Journal of Hand Surgery, 38(6), 1202-1208. https://doi.org/10.1016/j.jhsa.2013.02.032

How surgeons make decisions when the evidence is inconclusive. / Hageman, Michiel G J S; Guitton, Thierry G.; Ring, David; Lee Osterman, A.; Spoor, A. B.; Van Der Zwan, A. L.; Shrivastava, Abhay; Wahegaonkar, Abhijeet L.; Garcia, Aida E G; Aita, M. A.; Castillo, Alberto Pérez; Marcus, Alexander; Ladd, Amy; Terrono, Andrew L.; Gutow, Andrew P.; Schmidt, Andrew; Wang, Angela A.; Eschler, Anica; Miller, Anna N.; Wikerøy, Annette K B; Barquet, Antonio; Armstrong, April D.; Van Vugt, Arie B.; Bedi, Asheesh; Shyam, Ashok K.; Mazzocca, Augustus D.; Jubel, Axel; Reto, Babst H.; Nolan, Betsy M.; Arciero, Bob; Van Den, B.; Bamberger, Brent; Peterson, Bret C.; Crist, Brett D.; Cross, Brian J.; Badman, Brian L.; Henley, C. Noel; Ekholm, Carl; Swigart, Carrie; Manke, Chad; Zalavras, Charalampos; Goldfarb, Charles A.; Cassidy, Charles; Cornell, Charles; Getz, Charles L.; Metzger, Charles; Wilson, Chris; Heiss, Christian; Perrotto, Christian J.; Wall, Christopher J.; Walsh, Christopher J.; Garnavos, Christos; Jiang, Chunyan; Lomita, Craig; Torosian, Craig M.; Rikli, Daniel A.; Whelan, Daniel B.; Wascher, Daniel C.; Hernandez, Daniel; Polatsch, Daniel; Beingessner, Daphne; Drosdowech, Darren; Tate, David E.; Hak, David; Rowland, David J.; Kalainov, David M.; Nelson, David; Weiss, David; McKee, Desirae M.; Van Deurzen, D. F P; Endrizzi, Donald; Erol, Konul; Overbeck, Joachim P.; Baer, Wolfgang; Schwab, Eckart; Maza, Edgardo Ramos; Harvey, Edward; Rodriguez, Edward K.; Prelog-Igler, Elisabeth; Schemitsch, Emil H.; Shin, Eon K.; Hofmeister, Eric P.; Thomas, F.; Kaplan, D.; Beeres, F. J P; Suarez, Fabio; Fernandes, C. H.; Ernesto, Fidel; Cayón, Cayón; Dolatowski, Filip Celestyn; Martin, Fischmeister; Sierra, Francisco Javier Aguilar; Lopez-Gonzalez, Francisco; Walter, Frank; Seibert, Franz Josef; Baumgaertel, Fred; Frihagen, Frede; Fuchs, P. C.; Huemer, Georg M.; Kontakis, George; Athwal, George S.; Dyer, George S M; Thomas, George; Kohut, Georges; Williams, Gerald; Hernandez, German Ricardo; Caro, Gladys Cecilia Zambrano; Garrigues, Grant; Merrell, Greg; DeSilva, Gregory; Della Rocca, Gregory J.; Regazzi, Gustavo; De Azevedo, Gustavo Borges Laurindo; Ruggiero, Gustavo Mantovani; Helling, H. J.; MccUtchan, Hal; Goost, Hans; Kreder, Hans J.; Hasenboehler, Paula M.; Routman, Howard D.; Van Der Heide, Huub; Kleinlugtenbelt, I.; McGraw, Iain; Harris, Ian; Ibrahim, Ibrahim Mohammad; Lin, Ines C.; Iossifidis, A.; Trenholm, J. Andrew I; Goslings, J. Carel; Wiater, J. Michael; Choueka, Jack; Ahn, Jaimo; Kellam, James; Biert, Jan; Pomerance, Jay; Johnson, Jeff W.; Greenberg, Jeffrey A.; Yao, Jeffrey; Watson, Jeffry T.; Giuffre, Jennifer L.; Hall, Jeremy; Park, Jin Young; Fischer, Jochen; Murachovsky, Joel; Howlett, John; McAuliffe, John; Evans, John P.; Taras, John; Braman, Jonathan; Hobby, Jonathan L.; Rosenfeld, Jonathan; Boretto, Jorge; Orbay, Jorge; Rubio, Jorge; Ortiz, Jose A.; Abboud, Joseph; Conflitti, Joseph M.; Vroemen, Joseph P A M; Adams, Julie; Clarke, J. V.; Kabir, K.; Chivers, Karel; Prommersberger, Karl Josef; Segalman, Keith; Lee, Kendrick; Eng, Kevin; Chhor, Kimberlly S.; Ponsen, K. J.; Jeray, Kyle; Marsh, L.; Poelhekke, L. M S J; Mica, Ladislav; Borris, Lars C.; Halperin, Lawrence; Weiss, Lawrence; Benson, Leon; Elmans, Leon; De Mendonca, Leonardo Alves; Rocha, Leonardo; Katolik, Leonid; Lattanza, Lisa; Taitsman, Lisa; Guenter, Lob; Catalano, Louis; Buendia, Luis Antonio; Austin, Luke S.; Palmer, M. Jason; De Vries, M. R.; Krijnen, M. R.; Bronkhorst, Maarten W G A; Abdel-Ghany, Mahmoud I.; Van De Sande, M. A J; Swiontkowski, Marc; Rizzo, Marco; Lehnhardt, Marcus; Pirpiris, Marinis; Baratz, Mark; Lazarus, Mark D.; Boyer, Martin; Richardson, Martin; Kastelec, Matej; Mormino, Matt; Budge, Matthew D.; Turina, Matthias; Wood, Megan M.; Baskies, Michael; Baumgaertner, Michael; Behrman, Michael; Hausman, Michael; Jones, Michael; LeCroy, Michael; Moskal, Michael; Nancollas, Michael; Prayson, Michael; Grafe, Michael W.; Kessler, Michael W.; Van Den Bekerom, Michel P J; Mckee, Mike; Merchant, Milind; Tyllianakis, Minos; Felipe, Naquira Escobar Luis; Chen, Neal C.; Saran, Neil; Wilson, Neil; Shortt, Nicholas L.; Schep, Niels; Rossiter, Nigel; Lasanianos, N. G.; Kanakaris, Nikolaos; Weiss, Noah D.; Harvey, Norah M.; Van Eerten, P. V.; Melvanki, Parag; McCulloch, Patrick T.; Martineau, Paul A.; Appleton, Paul; Guidera, Paul; Levin, Paul; Giannoudis, Peter; Evans, Peter J.; Jebson, Peter; Kloen, Peter; Krause, Peter; Brink, Peter R G; Peters, J. H.; Blazar, Philip; Streubel, Philipp N.; Porcellini; Ina, Prashanth; Prashanth, S.; Solanki, Punita V.; Wang, Qiugen; Quell, M.; Benafield, R. Bryan; Haverlag, R.; Peters, R. W.; Varma, Rajat; Nyszkiewicz, Ralf; Costanzo, Ralph M.; De Bedout, Ramon; Ranade, Ashish S.; Smith, Raymond Malcolm; Abrams, Reid; Fricker, Renato M.; Omid, Reza; Barth, Richard; Buckley, Richard; Jenkinson, Richard; GIlbert, Richard S.; Page, Richard S.; Wallensten, Richard; Zura, Robert D.; Feibel, Robert J.; Gray, Robert R L; Tashijan, Robert; Wagenmakers, Robert; Pesantez, Rodrigo; Van Riet, Roger; Norlin, Rolf; Pfeifer, Roman; Liem, Ronald; LiemKulick, Roy G.; Rozental; Poolman, Rudolf W.; Shatford, Russell; Klinefelter, Ryan; Calfee, Ryan P.; Moghtaderi, Sam; Sodha, Samir; Sprujt, Sander; Kakar, Sanjeev; Kaplan, Saul; Schandelmaier; Duncan, Scott; Kluge, Sebastian; Rodriguez-Elizalde, Sebastian; Checchia, Sergio L.; Rowinski, Sergio; Dodds, Seth; Hurwit, Shep; Sprengel, K.; Van Der Stappen, W. A H; Kronlage, Steve; Beldner, Steven; McCabe, Steven J.; Morgan, Steven J.; Rhemrev, Steven J.; Hilliard, Stuart; Gosens, Taco; Sasaki, Takashi; Taleb, C.; Pritsch, Tamir; Tosounidis, Theodoros; Wyrick, Theresa; DeCoster, Thomas; Dienstknecht, Thomas; Stackhouse, Thomas G.; Hughes, Thomas; Wright, Thomas; Ly, Thuan V.; Havenhill, Timothy G.; Omara, Timothy; Siff, Todd; McLaurin, Toni M.; Wanich, Tony; Rueger, Johannes M.; Vallim, Frederico C M; Sabesan, Vani J.; Nikolaou, Vasileios S.; Verhofstad; Knoll, Victoria D.; Telang, Vidyadhar; Iyer, Vishwanath M.; Jokhi, Vispi; Batson, W. Arnnold; Willems, W. Jaap; Smith, Wade R.; Belangero, William Dias; Wolkenfelt, J.; Weil, Yoram.

In: Journal of Hand Surgery, Vol. 38, No. 6, 06.2013, p. 1202-1208.

Research output: Contribution to journalArticle

Hageman, MGJS, Guitton, TG, Ring, D, Lee Osterman, A, Spoor, AB, Van Der Zwan, AL, Shrivastava, A, Wahegaonkar, AL, Garcia, AEG, Aita, MA, Castillo, AP, Marcus, A, Ladd, A, Terrono, AL, Gutow, AP, Schmidt, A, Wang, AA, Eschler, A, Miller, AN, Wikerøy, AKB, Barquet, A, Armstrong, AD, Van Vugt, AB, Bedi, A, Shyam, AK, Mazzocca, AD, Jubel, A, Reto, BH, Nolan, BM, Arciero, B, Van Den, B, Bamberger, B, Peterson, BC, Crist, BD, Cross, BJ, Badman, BL, Henley, CN, Ekholm, C, Swigart, C, Manke, C, Zalavras, C, Goldfarb, CA, Cassidy, C, Cornell, C, Getz, CL, Metzger, C, Wilson, C, Heiss, C, Perrotto, CJ, Wall, CJ, Walsh, CJ, Garnavos, C, Jiang, C, Lomita, C, Torosian, CM, Rikli, DA, Whelan, DB, Wascher, DC, Hernandez, D, Polatsch, D, Beingessner, D, Drosdowech, D, Tate, DE, Hak, D, Rowland, DJ, Kalainov, DM, Nelson, D, Weiss, D, McKee, DM, Van Deurzen, DFP, Endrizzi, D, Erol, K, Overbeck, JP, Baer, W, Schwab, E, Maza, ER, Harvey, E, Rodriguez, EK, Prelog-Igler, E, Schemitsch, EH, Shin, EK, Hofmeister, EP, Thomas, F, Kaplan, D, Beeres, FJP, Suarez, F, Fernandes, CH, Ernesto, F, Cayón, C, Dolatowski, FC, Martin, F, Sierra, FJA, Lopez-Gonzalez, F, Walter, F, Seibert, FJ, Baumgaertel, F, Frihagen, F, Fuchs, PC, Huemer, GM, Kontakis, G, Athwal, GS, Dyer, GSM, Thomas, G, Kohut, G, Williams, G, Hernandez, GR, Caro, GCZ, Garrigues, G, Merrell, G, DeSilva, G, Della Rocca, GJ, Regazzi, G, De Azevedo, GBL, Ruggiero, GM, Helling, HJ, MccUtchan, H, Goost, H, Kreder, HJ, Hasenboehler, PM, Routman, HD, Van Der Heide, H, Kleinlugtenbelt, I, McGraw, I, Harris, I, Ibrahim, IM, Lin, IC, Iossifidis, A, Trenholm, JAI, Goslings, JC, Wiater, JM, Choueka, J, Ahn, J, Kellam, J, Biert, J, Pomerance, J, Johnson, JW, Greenberg, JA, Yao, J, Watson, JT, Giuffre, JL, Hall, J, Park, JY, Fischer, J, Murachovsky, J, Howlett, J, McAuliffe, J, Evans, JP, Taras, J, Braman, J, Hobby, JL, Rosenfeld, J, Boretto, J, Orbay, J, Rubio, J, Ortiz, JA, Abboud, J, Conflitti, JM, Vroemen, JPAM, Adams, J, Clarke, JV, Kabir, K, Chivers, K, Prommersberger, KJ, Segalman, K, Lee, K, Eng, K, Chhor, KS, Ponsen, KJ, Jeray, K, Marsh, L, Poelhekke, LMSJ, Mica, L, Borris, LC, Halperin, L, Weiss, L, Benson, L, Elmans, L, De Mendonca, LA, Rocha, L, Katolik, L, Lattanza, L, Taitsman, L, Guenter, L, Catalano, L, Buendia, LA, Austin, LS, Palmer, MJ, De Vries, MR, Krijnen, MR, Bronkhorst, MWGA, Abdel-Ghany, MI, Van De Sande, MAJ, Swiontkowski, M, Rizzo, M, Lehnhardt, M, Pirpiris, M, Baratz, M, Lazarus, MD, Boyer, M, Richardson, M, Kastelec, M, Mormino, M, Budge, MD, Turina, M, Wood, MM, Baskies, M, Baumgaertner, M, Behrman, M, Hausman, M, Jones, M, LeCroy, M, Moskal, M, Nancollas, M, Prayson, M, Grafe, MW, Kessler, MW, Van Den Bekerom, MPJ, Mckee, M, Merchant, M, Tyllianakis, M, Felipe, NEL, Chen, NC, Saran, N, Wilson, N, Shortt, NL, Schep, N, Rossiter, N, Lasanianos, NG, Kanakaris, N, Weiss, ND, Harvey, NM, Van Eerten, PV, Melvanki, P, McCulloch, PT, Martineau, PA, Appleton, P, Guidera, P, Levin, P, Giannoudis, P, Evans, PJ, Jebson, P, Kloen, P, Krause, P, Brink, PRG, Peters, JH, Blazar, P, Streubel, PN, Porcellini, Ina, P, Prashanth, S, Solanki, PV, Wang, Q, Quell, M, Benafield, RB, Haverlag, R, Peters, RW, Varma, R, Nyszkiewicz, R, Costanzo, RM, De Bedout, R, Ranade, AS, Smith, RM, Abrams, R, Fricker, RM, Omid, R, Barth, R, Buckley, R, Jenkinson, R, GIlbert, RS, Page, RS, Wallensten, R, Zura, RD, Feibel, RJ, Gray, RRL, Tashijan, R, Wagenmakers, R, Pesantez, R, Van Riet, R, Norlin, R, Pfeifer, R, Liem, R, LiemKulick, RG, Rozental, Poolman, RW, Shatford, R, Klinefelter, R, Calfee, RP, Moghtaderi, S, Sodha, S, Sprujt, S, Kakar, S, Kaplan, S, Schandelmaier, Duncan, S, Kluge, S, Rodriguez-Elizalde, S, Checchia, SL, Rowinski, S, Dodds, S, Hurwit, S, Sprengel, K, Van Der Stappen, WAH, Kronlage, S, Beldner, S, McCabe, SJ, Morgan, SJ, Rhemrev, SJ, Hilliard, S, Gosens, T, Sasaki, T, Taleb, C, Pritsch, T, Tosounidis, T, Wyrick, T, DeCoster, T, Dienstknecht, T, Stackhouse, TG, Hughes, T, Wright, T, Ly, TV, Havenhill, TG, Omara, T, Siff, T, McLaurin, TM, Wanich, T, Rueger, JM, Vallim, FCM, Sabesan, VJ, Nikolaou, VS, Verhofstad, Knoll, VD, Telang, V, Iyer, VM, Jokhi, V, Batson, WA, Willems, WJ, Smith, WR, Belangero, WD, Wolkenfelt, J & Weil, Y 2013, 'How surgeons make decisions when the evidence is inconclusive', Journal of Hand Surgery, vol. 38, no. 6, pp. 1202-1208. https://doi.org/10.1016/j.jhsa.2013.02.032
Hageman MGJS, Guitton TG, Ring D, Lee Osterman A, Spoor AB, Van Der Zwan AL et al. How surgeons make decisions when the evidence is inconclusive. Journal of Hand Surgery. 2013 Jun;38(6):1202-1208. https://doi.org/10.1016/j.jhsa.2013.02.032
Hageman, Michiel G J S ; Guitton, Thierry G. ; Ring, David ; Lee Osterman, A. ; Spoor, A. B. ; Van Der Zwan, A. L. ; Shrivastava, Abhay ; Wahegaonkar, Abhijeet L. ; Garcia, Aida E G ; Aita, M. A. ; Castillo, Alberto Pérez ; Marcus, Alexander ; Ladd, Amy ; Terrono, Andrew L. ; Gutow, Andrew P. ; Schmidt, Andrew ; Wang, Angela A. ; Eschler, Anica ; Miller, Anna N. ; Wikerøy, Annette K B ; Barquet, Antonio ; Armstrong, April D. ; Van Vugt, Arie B. ; Bedi, Asheesh ; Shyam, Ashok K. ; Mazzocca, Augustus D. ; Jubel, Axel ; Reto, Babst H. ; Nolan, Betsy M. ; Arciero, Bob ; Van Den, B. ; Bamberger, Brent ; Peterson, Bret C. ; Crist, Brett D. ; Cross, Brian J. ; Badman, Brian L. ; Henley, C. Noel ; Ekholm, Carl ; Swigart, Carrie ; Manke, Chad ; Zalavras, Charalampos ; Goldfarb, Charles A. ; Cassidy, Charles ; Cornell, Charles ; Getz, Charles L. ; Metzger, Charles ; Wilson, Chris ; Heiss, Christian ; Perrotto, Christian J. ; Wall, Christopher J. ; Walsh, Christopher J. ; Garnavos, Christos ; Jiang, Chunyan ; Lomita, Craig ; Torosian, Craig M. ; Rikli, Daniel A. ; Whelan, Daniel B. ; Wascher, Daniel C. ; Hernandez, Daniel ; Polatsch, Daniel ; Beingessner, Daphne ; Drosdowech, Darren ; Tate, David E. ; Hak, David ; Rowland, David J. ; Kalainov, David M. ; Nelson, David ; Weiss, David ; McKee, Desirae M. ; Van Deurzen, D. F P ; Endrizzi, Donald ; Erol, Konul ; Overbeck, Joachim P. ; Baer, Wolfgang ; Schwab, Eckart ; Maza, Edgardo Ramos ; Harvey, Edward ; Rodriguez, Edward K. ; Prelog-Igler, Elisabeth ; Schemitsch, Emil H. ; Shin, Eon K. ; Hofmeister, Eric P. ; Thomas, F. ; Kaplan, D. ; Beeres, F. J P ; Suarez, Fabio ; Fernandes, C. H. ; Ernesto, Fidel ; Cayón, Cayón ; Dolatowski, Filip Celestyn ; Martin, Fischmeister ; Sierra, Francisco Javier Aguilar ; Lopez-Gonzalez, Francisco ; Walter, Frank ; Seibert, Franz Josef ; Baumgaertel, Fred ; Frihagen, Frede ; Fuchs, P. C. ; Huemer, Georg M. ; Kontakis, George ; Athwal, George S. ; Dyer, George S M ; Thomas, George ; Kohut, Georges ; Williams, Gerald ; Hernandez, German Ricardo ; Caro, Gladys Cecilia Zambrano ; Garrigues, Grant ; Merrell, Greg ; DeSilva, Gregory ; Della Rocca, Gregory J. ; Regazzi, Gustavo ; De Azevedo, Gustavo Borges Laurindo ; Ruggiero, Gustavo Mantovani ; Helling, H. J. ; MccUtchan, Hal ; Goost, Hans ; Kreder, Hans J. ; Hasenboehler, Paula M. ; Routman, Howard D. ; Van Der Heide, Huub ; Kleinlugtenbelt, I. ; McGraw, Iain ; Harris, Ian ; Ibrahim, Ibrahim Mohammad ; Lin, Ines C. ; Iossifidis, A. ; Trenholm, J. Andrew I ; Goslings, J. Carel ; Wiater, J. Michael ; Choueka, Jack ; Ahn, Jaimo ; Kellam, James ; Biert, Jan ; Pomerance, Jay ; Johnson, Jeff W. ; Greenberg, Jeffrey A. ; Yao, Jeffrey ; Watson, Jeffry T. ; Giuffre, Jennifer L. ; Hall, Jeremy ; Park, Jin Young ; Fischer, Jochen ; Murachovsky, Joel ; Howlett, John ; McAuliffe, John ; Evans, John P. ; Taras, John ; Braman, Jonathan ; Hobby, Jonathan L. ; Rosenfeld, Jonathan ; Boretto, Jorge ; Orbay, Jorge ; Rubio, Jorge ; Ortiz, Jose A. ; Abboud, Joseph ; Conflitti, Joseph M. ; Vroemen, Joseph P A M ; Adams, Julie ; Clarke, J. V. ; Kabir, K. ; Chivers, Karel ; Prommersberger, Karl Josef ; Segalman, Keith ; Lee, Kendrick ; Eng, Kevin ; Chhor, Kimberlly S. ; Ponsen, K. J. ; Jeray, Kyle ; Marsh, L. ; Poelhekke, L. M S J ; Mica, Ladislav ; Borris, Lars C. ; Halperin, Lawrence ; Weiss, Lawrence ; Benson, Leon ; Elmans, Leon ; De Mendonca, Leonardo Alves ; Rocha, Leonardo ; Katolik, Leonid ; Lattanza, Lisa ; Taitsman, Lisa ; Guenter, Lob ; Catalano, Louis ; Buendia, Luis Antonio ; Austin, Luke S. ; Palmer, M. Jason ; De Vries, M. R. ; Krijnen, M. R. ; Bronkhorst, Maarten W G A ; Abdel-Ghany, Mahmoud I. ; Van De Sande, M. A J ; Swiontkowski, Marc ; Rizzo, Marco ; Lehnhardt, Marcus ; Pirpiris, Marinis ; Baratz, Mark ; Lazarus, Mark D. ; Boyer, Martin ; Richardson, Martin ; Kastelec, Matej ; Mormino, Matt ; Budge, Matthew D. ; Turina, Matthias ; Wood, Megan M. ; Baskies, Michael ; Baumgaertner, Michael ; Behrman, Michael ; Hausman, Michael ; Jones, Michael ; LeCroy, Michael ; Moskal, Michael ; Nancollas, Michael ; Prayson, Michael ; Grafe, Michael W. ; Kessler, Michael W. ; Van Den Bekerom, Michel P J ; Mckee, Mike ; Merchant, Milind ; Tyllianakis, Minos ; Felipe, Naquira Escobar Luis ; Chen, Neal C. ; Saran, Neil ; Wilson, Neil ; Shortt, Nicholas L. ; Schep, Niels ; Rossiter, Nigel ; Lasanianos, N. G. ; Kanakaris, Nikolaos ; Weiss, Noah D. ; Harvey, Norah M. ; Van Eerten, P. V. ; Melvanki, Parag ; McCulloch, Patrick T. ; Martineau, Paul A. ; Appleton, Paul ; Guidera, Paul ; Levin, Paul ; Giannoudis, Peter ; Evans, Peter J. ; Jebson, Peter ; Kloen, Peter ; Krause, Peter ; Brink, Peter R G ; Peters, J. H. ; Blazar, Philip ; Streubel, Philipp N. ; Porcellini ; Ina, Prashanth ; Prashanth, S. ; Solanki, Punita V. ; Wang, Qiugen ; Quell, M. ; Benafield, R. Bryan ; Haverlag, R. ; Peters, R. W. ; Varma, Rajat ; Nyszkiewicz, Ralf ; Costanzo, Ralph M. ; De Bedout, Ramon ; Ranade, Ashish S. ; Smith, Raymond Malcolm ; Abrams, Reid ; Fricker, Renato M. ; Omid, Reza ; Barth, Richard ; Buckley, Richard ; Jenkinson, Richard ; GIlbert, Richard S. ; Page, Richard S. ; Wallensten, Richard ; Zura, Robert D. ; Feibel, Robert J. ; Gray, Robert R L ; Tashijan, Robert ; Wagenmakers, Robert ; Pesantez, Rodrigo ; Van Riet, Roger ; Norlin, Rolf ; Pfeifer, Roman ; Liem, Ronald ; LiemKulick, Roy G. ; Rozental ; Poolman, Rudolf W. ; Shatford, Russell ; Klinefelter, Ryan ; Calfee, Ryan P. ; Moghtaderi, Sam ; Sodha, Samir ; Sprujt, Sander ; Kakar, Sanjeev ; Kaplan, Saul ; Schandelmaier ; Duncan, Scott ; Kluge, Sebastian ; Rodriguez-Elizalde, Sebastian ; Checchia, Sergio L. ; Rowinski, Sergio ; Dodds, Seth ; Hurwit, Shep ; Sprengel, K. ; Van Der Stappen, W. A H ; Kronlage, Steve ; Beldner, Steven ; McCabe, Steven J. ; Morgan, Steven J. ; Rhemrev, Steven J. ; Hilliard, Stuart ; Gosens, Taco ; Sasaki, Takashi ; Taleb, C. ; Pritsch, Tamir ; Tosounidis, Theodoros ; Wyrick, Theresa ; DeCoster, Thomas ; Dienstknecht, Thomas ; Stackhouse, Thomas G. ; Hughes, Thomas ; Wright, Thomas ; Ly, Thuan V. ; Havenhill, Timothy G. ; Omara, Timothy ; Siff, Todd ; McLaurin, Toni M. ; Wanich, Tony ; Rueger, Johannes M. ; Vallim, Frederico C M ; Sabesan, Vani J. ; Nikolaou, Vasileios S. ; Verhofstad ; Knoll, Victoria D. ; Telang, Vidyadhar ; Iyer, Vishwanath M. ; Jokhi, Vispi ; Batson, W. Arnnold ; Willems, W. Jaap ; Smith, Wade R. ; Belangero, William Dias ; Wolkenfelt, J. ; Weil, Yoram. / How surgeons make decisions when the evidence is inconclusive. In: Journal of Hand Surgery. 2013 ; Vol. 38, No. 6. pp. 1202-1208.
@article{7eb1e1077dca4db8bc2c0e800500370b,
title = "How surgeons make decisions when the evidence is inconclusive",
abstract = "Purpose To address the factors that surgeons use to decide between 2 options for treatment when the evidence is inconclusive. Methods We tested the null hypothesis that the factors surgeons use do not vary by training, demographics, and practice. A total of 337 surgeons rated the importance of 7 factors when deciding between treatment and following the natural history of the disease and 12 factors when deciding between 2 operative treatments using a 5-point Likert scale between 'very important' and 'very unimportant.' Results According to the percentages of statements rated very important or somewhat important, the most popular factors influencing recommendations when evidence is inconclusive between treatment and following the natural course of the illness were 'works in my hands,' 'familiarity with the treatment,' and 'what my mentor taught me.' The most important factors when evidence shows no difference between 2 surgeries were 'fewer complications,' 'quicker recovery,' 'burns fewer bridges,' 'works in my hands' and 'familiarity with the procedure.' Europeans rated 'works in my hands' and 'cheapest/most resourceful' of significantly greater importance and 'what others are doing,' 'highest reimbursement,' and 'shorter procedure' of significantly lower importance than surgeons in the United States. Observers with fewer than 10 years in independent practice rated 'what my mentor taught me,' 'what others are doing' and 'highest reimbursement' of significantly lower importance compared to observers with 10 or more years in independent practice. Conclusions Surgeons deciding between 2 treatment options, when the evidence is inconclusive, fall back to factors that relate to their perspective and reflect their culture and circumstances, more so than factors related to the patient's perspective, although this may be different for younger surgeons. Clinical relevance Hand surgeons might benefit from consensus fallback preferences when evidence is inconclusive. It is possible that falling back to personal comfort makes us vulnerable to unhelpful commercial and societal influences.",
keywords = "Decision making, Evidence-based medicine, Treatment",
author = "Hageman, {Michiel G J S} and Guitton, {Thierry G.} and David Ring and {Lee Osterman}, A. and Spoor, {A. B.} and {Van Der Zwan}, {A. L.} and Abhay Shrivastava and Wahegaonkar, {Abhijeet L.} and Garcia, {Aida E G} and Aita, {M. A.} and Castillo, {Alberto P{\'e}rez} and Alexander Marcus and Amy Ladd and Terrono, {Andrew L.} and Gutow, {Andrew P.} and Andrew Schmidt and Wang, {Angela A.} and Anica Eschler and Miller, {Anna N.} and Wiker{\o}y, {Annette K B} and Antonio Barquet and Armstrong, {April D.} and {Van Vugt}, {Arie B.} and Asheesh Bedi and Shyam, {Ashok K.} and Mazzocca, {Augustus D.} and Axel Jubel and Reto, {Babst H.} and Nolan, {Betsy M.} and Bob Arciero and {Van Den}, B. and Brent Bamberger and Peterson, {Bret C.} and Crist, {Brett D.} and Cross, {Brian J.} and Badman, {Brian L.} and Henley, {C. Noel} and Carl Ekholm and Carrie Swigart and Chad Manke and Charalampos Zalavras and Goldfarb, {Charles A.} and Charles Cassidy and Charles Cornell and Getz, {Charles L.} and Charles Metzger and Chris Wilson and Christian Heiss and Perrotto, {Christian J.} and Wall, {Christopher J.} and Walsh, {Christopher J.} and Christos Garnavos and Chunyan Jiang and Craig Lomita and Torosian, {Craig M.} and Rikli, {Daniel A.} and Whelan, {Daniel B.} and Wascher, {Daniel C.} and Daniel Hernandez and Daniel Polatsch and Daphne Beingessner and Darren Drosdowech and Tate, {David E.} and David Hak and Rowland, {David J.} and Kalainov, {David M.} and David Nelson and David Weiss and McKee, {Desirae M.} and {Van Deurzen}, {D. F P} and Donald Endrizzi and Konul Erol and Overbeck, {Joachim P.} and Wolfgang Baer and Eckart Schwab and Maza, {Edgardo Ramos} and Edward Harvey and Rodriguez, {Edward K.} and Elisabeth Prelog-Igler and Schemitsch, {Emil H.} and Shin, {Eon K.} and Hofmeister, {Eric P.} and F. Thomas and D. Kaplan and Beeres, {F. J P} and Fabio Suarez and Fernandes, {C. H.} and Fidel Ernesto and Cay{\'o}n Cay{\'o}n and Dolatowski, {Filip Celestyn} and Fischmeister Martin and Sierra, {Francisco Javier Aguilar} and Francisco Lopez-Gonzalez and Frank Walter and Seibert, {Franz Josef} and Fred Baumgaertel and Frede Frihagen and Fuchs, {P. C.} and Huemer, {Georg M.} and George Kontakis and Athwal, {George S.} and Dyer, {George S M} and George Thomas and Georges Kohut and Gerald Williams and Hernandez, {German Ricardo} and Caro, {Gladys Cecilia Zambrano} and Grant Garrigues and Greg Merrell and Gregory DeSilva and {Della Rocca}, {Gregory J.} and Gustavo Regazzi and {De Azevedo}, {Gustavo Borges Laurindo} and Ruggiero, {Gustavo Mantovani} and Helling, {H. J.} and Hal MccUtchan and Hans Goost and Kreder, {Hans J.} and Hasenboehler, {Paula M.} and Routman, {Howard D.} and {Van Der Heide}, Huub and I. Kleinlugtenbelt and Iain McGraw and Ian Harris and Ibrahim, {Ibrahim Mohammad} and Lin, {Ines C.} and A. Iossifidis and Trenholm, {J. Andrew I} and Goslings, {J. Carel} and Wiater, {J. Michael} and Jack Choueka and Jaimo Ahn and James Kellam and Jan Biert and Jay Pomerance and Johnson, {Jeff W.} and Greenberg, {Jeffrey A.} and Jeffrey Yao and Watson, {Jeffry T.} and Giuffre, {Jennifer L.} and Jeremy Hall and Park, {Jin Young} and Jochen Fischer and Joel Murachovsky and John Howlett and John McAuliffe and Evans, {John P.} and John Taras and Jonathan Braman and Hobby, {Jonathan L.} and Jonathan Rosenfeld and Jorge Boretto and Jorge Orbay and Jorge Rubio and Ortiz, {Jose A.} and Joseph Abboud and Conflitti, {Joseph M.} and Vroemen, {Joseph P A M} and Julie Adams and Clarke, {J. V.} and K. Kabir and Karel Chivers and Prommersberger, {Karl Josef} and Keith Segalman and Kendrick Lee and Kevin Eng and Chhor, {Kimberlly S.} and Ponsen, {K. J.} and Kyle Jeray and L. Marsh and Poelhekke, {L. M S J} and Ladislav Mica and Borris, {Lars C.} and Lawrence Halperin and Lawrence Weiss and Leon Benson and Leon Elmans and {De Mendonca}, {Leonardo Alves} and Leonardo Rocha and Leonid Katolik and Lisa Lattanza and Lisa Taitsman and Lob Guenter and Louis Catalano and Buendia, {Luis Antonio} and Austin, {Luke S.} and Palmer, {M. Jason} and {De Vries}, {M. R.} and Krijnen, {M. R.} and Bronkhorst, {Maarten W G A} and Abdel-Ghany, {Mahmoud I.} and {Van De Sande}, {M. A J} and Marc Swiontkowski and Marco Rizzo and Marcus Lehnhardt and Marinis Pirpiris and Mark Baratz and Lazarus, {Mark D.} and Martin Boyer and Martin Richardson and Matej Kastelec and Matt Mormino and Budge, {Matthew D.} and Matthias Turina and Wood, {Megan M.} and Michael Baskies and Michael Baumgaertner and Michael Behrman and Michael Hausman and Michael Jones and Michael LeCroy and Michael Moskal and Michael Nancollas and Michael Prayson and Grafe, {Michael W.} and Kessler, {Michael W.} and {Van Den Bekerom}, {Michel P J} and Mike Mckee and Milind Merchant and Minos Tyllianakis and Felipe, {Naquira Escobar Luis} and Chen, {Neal C.} and Neil Saran and Neil Wilson and Shortt, {Nicholas L.} and Niels Schep and Nigel Rossiter and Lasanianos, {N. G.} and Nikolaos Kanakaris and Weiss, {Noah D.} and Harvey, {Norah M.} and {Van Eerten}, {P. V.} and Parag Melvanki and McCulloch, {Patrick T.} and Martineau, {Paul A.} and Paul Appleton and Paul Guidera and Paul Levin and Peter Giannoudis and Evans, {Peter J.} and Peter Jebson and Peter Kloen and Peter Krause and Brink, {Peter R G} and Peters, {J. H.} and Philip Blazar and Streubel, {Philipp N.} and Porcellini and Prashanth Ina and S. Prashanth and Solanki, {Punita V.} and Qiugen Wang and M. Quell and Benafield, {R. Bryan} and R. Haverlag and Peters, {R. W.} and Rajat Varma and Ralf Nyszkiewicz and Costanzo, {Ralph M.} and {De Bedout}, Ramon and Ranade, {Ashish S.} and Smith, {Raymond Malcolm} and Reid Abrams and Fricker, {Renato M.} and Reza Omid and Richard Barth and Richard Buckley and Richard Jenkinson and GIlbert, {Richard S.} and Page, {Richard S.} and Richard Wallensten and Zura, {Robert D.} and Feibel, {Robert J.} and Gray, {Robert R L} and Robert Tashijan and Robert Wagenmakers and Rodrigo Pesantez and {Van Riet}, Roger and Rolf Norlin and Roman Pfeifer and Ronald Liem and LiemKulick, {Roy G.} and Rozental and Poolman, {Rudolf W.} and Russell Shatford and Ryan Klinefelter and Calfee, {Ryan P.} and Sam Moghtaderi and Samir Sodha and Sander Sprujt and Sanjeev Kakar and Saul Kaplan and Schandelmaier and Scott Duncan and Sebastian Kluge and Sebastian Rodriguez-Elizalde and Checchia, {Sergio L.} and Sergio Rowinski and Seth Dodds and Shep Hurwit and K. Sprengel and {Van Der Stappen}, {W. A H} and Steve Kronlage and Steven Beldner and McCabe, {Steven J.} and Morgan, {Steven J.} and Rhemrev, {Steven J.} and Stuart Hilliard and Taco Gosens and Takashi Sasaki and C. Taleb and Tamir Pritsch and Theodoros Tosounidis and Theresa Wyrick and Thomas DeCoster and Thomas Dienstknecht and Stackhouse, {Thomas G.} and Thomas Hughes and Thomas Wright and Ly, {Thuan V.} and Havenhill, {Timothy G.} and Timothy Omara and Todd Siff and McLaurin, {Toni M.} and Tony Wanich and Rueger, {Johannes M.} and Vallim, {Frederico C M} and Sabesan, {Vani J.} and Nikolaou, {Vasileios S.} and Verhofstad and Knoll, {Victoria D.} and Vidyadhar Telang and Iyer, {Vishwanath M.} and Vispi Jokhi and Batson, {W. Arnnold} and Willems, {W. Jaap} and Smith, {Wade R.} and Belangero, {William Dias} and J. Wolkenfelt and Yoram Weil",
year = "2013",
month = "6",
doi = "10.1016/j.jhsa.2013.02.032",
language = "English (US)",
volume = "38",
pages = "1202--1208",
journal = "Journal of Hand Surgery",
issn = "0363-5023",
publisher = "W.B. Saunders Ltd",
number = "6",

}

TY - JOUR

T1 - How surgeons make decisions when the evidence is inconclusive

AU - Hageman, Michiel G J S

AU - Guitton, Thierry G.

AU - Ring, David

AU - Lee Osterman, A.

AU - Spoor, A. B.

AU - Van Der Zwan, A. L.

AU - Shrivastava, Abhay

AU - Wahegaonkar, Abhijeet L.

AU - Garcia, Aida E G

AU - Aita, M. A.

AU - Castillo, Alberto Pérez

AU - Marcus, Alexander

AU - Ladd, Amy

AU - Terrono, Andrew L.

AU - Gutow, Andrew P.

AU - Schmidt, Andrew

AU - Wang, Angela A.

AU - Eschler, Anica

AU - Miller, Anna N.

AU - Wikerøy, Annette K B

AU - Barquet, Antonio

AU - Armstrong, April D.

AU - Van Vugt, Arie B.

AU - Bedi, Asheesh

AU - Shyam, Ashok K.

AU - Mazzocca, Augustus D.

AU - Jubel, Axel

AU - Reto, Babst H.

AU - Nolan, Betsy M.

AU - Arciero, Bob

AU - Van Den, B.

AU - Bamberger, Brent

AU - Peterson, Bret C.

AU - Crist, Brett D.

AU - Cross, Brian J.

AU - Badman, Brian L.

AU - Henley, C. Noel

AU - Ekholm, Carl

AU - Swigart, Carrie

AU - Manke, Chad

AU - Zalavras, Charalampos

AU - Goldfarb, Charles A.

AU - Cassidy, Charles

AU - Cornell, Charles

AU - Getz, Charles L.

AU - Metzger, Charles

AU - Wilson, Chris

AU - Heiss, Christian

AU - Perrotto, Christian J.

AU - Wall, Christopher J.

AU - Walsh, Christopher J.

AU - Garnavos, Christos

AU - Jiang, Chunyan

AU - Lomita, Craig

AU - Torosian, Craig M.

AU - Rikli, Daniel A.

AU - Whelan, Daniel B.

AU - Wascher, Daniel C.

AU - Hernandez, Daniel

AU - Polatsch, Daniel

AU - Beingessner, Daphne

AU - Drosdowech, Darren

AU - Tate, David E.

AU - Hak, David

AU - Rowland, David J.

AU - Kalainov, David M.

AU - Nelson, David

AU - Weiss, David

AU - McKee, Desirae M.

AU - Van Deurzen, D. F P

AU - Endrizzi, Donald

AU - Erol, Konul

AU - Overbeck, Joachim P.

AU - Baer, Wolfgang

AU - Schwab, Eckart

AU - Maza, Edgardo Ramos

AU - Harvey, Edward

AU - Rodriguez, Edward K.

AU - Prelog-Igler, Elisabeth

AU - Schemitsch, Emil H.

AU - Shin, Eon K.

AU - Hofmeister, Eric P.

AU - Thomas, F.

AU - Kaplan, D.

AU - Beeres, F. J P

AU - Suarez, Fabio

AU - Fernandes, C. H.

AU - Ernesto, Fidel

AU - Cayón, Cayón

AU - Dolatowski, Filip Celestyn

AU - Martin, Fischmeister

AU - Sierra, Francisco Javier Aguilar

AU - Lopez-Gonzalez, Francisco

AU - Walter, Frank

AU - Seibert, Franz Josef

AU - Baumgaertel, Fred

AU - Frihagen, Frede

AU - Fuchs, P. C.

AU - Huemer, Georg M.

AU - Kontakis, George

AU - Athwal, George S.

AU - Dyer, George S M

AU - Thomas, George

AU - Kohut, Georges

AU - Williams, Gerald

AU - Hernandez, German Ricardo

AU - Caro, Gladys Cecilia Zambrano

AU - Garrigues, Grant

AU - Merrell, Greg

AU - DeSilva, Gregory

AU - Della Rocca, Gregory J.

AU - Regazzi, Gustavo

AU - De Azevedo, Gustavo Borges Laurindo

AU - Ruggiero, Gustavo Mantovani

AU - Helling, H. J.

AU - MccUtchan, Hal

AU - Goost, Hans

AU - Kreder, Hans J.

AU - Hasenboehler, Paula M.

AU - Routman, Howard D.

AU - Van Der Heide, Huub

AU - Kleinlugtenbelt, I.

AU - McGraw, Iain

AU - Harris, Ian

AU - Ibrahim, Ibrahim Mohammad

AU - Lin, Ines C.

AU - Iossifidis, A.

AU - Trenholm, J. Andrew I

AU - Goslings, J. Carel

AU - Wiater, J. Michael

AU - Choueka, Jack

AU - Ahn, Jaimo

AU - Kellam, James

AU - Biert, Jan

AU - Pomerance, Jay

AU - Johnson, Jeff W.

AU - Greenberg, Jeffrey A.

AU - Yao, Jeffrey

AU - Watson, Jeffry T.

AU - Giuffre, Jennifer L.

AU - Hall, Jeremy

AU - Park, Jin Young

AU - Fischer, Jochen

AU - Murachovsky, Joel

AU - Howlett, John

AU - McAuliffe, John

AU - Evans, John P.

AU - Taras, John

AU - Braman, Jonathan

AU - Hobby, Jonathan L.

AU - Rosenfeld, Jonathan

AU - Boretto, Jorge

AU - Orbay, Jorge

AU - Rubio, Jorge

AU - Ortiz, Jose A.

AU - Abboud, Joseph

AU - Conflitti, Joseph M.

AU - Vroemen, Joseph P A M

AU - Adams, Julie

AU - Clarke, J. V.

AU - Kabir, K.

AU - Chivers, Karel

AU - Prommersberger, Karl Josef

AU - Segalman, Keith

AU - Lee, Kendrick

AU - Eng, Kevin

AU - Chhor, Kimberlly S.

AU - Ponsen, K. J.

AU - Jeray, Kyle

AU - Marsh, L.

AU - Poelhekke, L. M S J

AU - Mica, Ladislav

AU - Borris, Lars C.

AU - Halperin, Lawrence

AU - Weiss, Lawrence

AU - Benson, Leon

AU - Elmans, Leon

AU - De Mendonca, Leonardo Alves

AU - Rocha, Leonardo

AU - Katolik, Leonid

AU - Lattanza, Lisa

AU - Taitsman, Lisa

AU - Guenter, Lob

AU - Catalano, Louis

AU - Buendia, Luis Antonio

AU - Austin, Luke S.

AU - Palmer, M. Jason

AU - De Vries, M. R.

AU - Krijnen, M. R.

AU - Bronkhorst, Maarten W G A

AU - Abdel-Ghany, Mahmoud I.

AU - Van De Sande, M. A J

AU - Swiontkowski, Marc

AU - Rizzo, Marco

AU - Lehnhardt, Marcus

AU - Pirpiris, Marinis

AU - Baratz, Mark

AU - Lazarus, Mark D.

AU - Boyer, Martin

AU - Richardson, Martin

AU - Kastelec, Matej

AU - Mormino, Matt

AU - Budge, Matthew D.

AU - Turina, Matthias

AU - Wood, Megan M.

AU - Baskies, Michael

AU - Baumgaertner, Michael

AU - Behrman, Michael

AU - Hausman, Michael

AU - Jones, Michael

AU - LeCroy, Michael

AU - Moskal, Michael

AU - Nancollas, Michael

AU - Prayson, Michael

AU - Grafe, Michael W.

AU - Kessler, Michael W.

AU - Van Den Bekerom, Michel P J

AU - Mckee, Mike

AU - Merchant, Milind

AU - Tyllianakis, Minos

AU - Felipe, Naquira Escobar Luis

AU - Chen, Neal C.

AU - Saran, Neil

AU - Wilson, Neil

AU - Shortt, Nicholas L.

AU - Schep, Niels

AU - Rossiter, Nigel

AU - Lasanianos, N. G.

AU - Kanakaris, Nikolaos

AU - Weiss, Noah D.

AU - Harvey, Norah M.

AU - Van Eerten, P. V.

AU - Melvanki, Parag

AU - McCulloch, Patrick T.

AU - Martineau, Paul A.

AU - Appleton, Paul

AU - Guidera, Paul

AU - Levin, Paul

AU - Giannoudis, Peter

AU - Evans, Peter J.

AU - Jebson, Peter

AU - Kloen, Peter

AU - Krause, Peter

AU - Brink, Peter R G

AU - Peters, J. H.

AU - Blazar, Philip

AU - Streubel, Philipp N.

AU - Porcellini,

AU - Ina, Prashanth

AU - Prashanth, S.

AU - Solanki, Punita V.

AU - Wang, Qiugen

AU - Quell, M.

AU - Benafield, R. Bryan

AU - Haverlag, R.

AU - Peters, R. W.

AU - Varma, Rajat

AU - Nyszkiewicz, Ralf

AU - Costanzo, Ralph M.

AU - De Bedout, Ramon

AU - Ranade, Ashish S.

AU - Smith, Raymond Malcolm

AU - Abrams, Reid

AU - Fricker, Renato M.

AU - Omid, Reza

AU - Barth, Richard

AU - Buckley, Richard

AU - Jenkinson, Richard

AU - GIlbert, Richard S.

AU - Page, Richard S.

AU - Wallensten, Richard

AU - Zura, Robert D.

AU - Feibel, Robert J.

AU - Gray, Robert R L

AU - Tashijan, Robert

AU - Wagenmakers, Robert

AU - Pesantez, Rodrigo

AU - Van Riet, Roger

AU - Norlin, Rolf

AU - Pfeifer, Roman

AU - Liem, Ronald

AU - LiemKulick, Roy G.

AU - Rozental,

AU - Poolman, Rudolf W.

AU - Shatford, Russell

AU - Klinefelter, Ryan

AU - Calfee, Ryan P.

AU - Moghtaderi, Sam

AU - Sodha, Samir

AU - Sprujt, Sander

AU - Kakar, Sanjeev

AU - Kaplan, Saul

AU - Schandelmaier,

AU - Duncan, Scott

AU - Kluge, Sebastian

AU - Rodriguez-Elizalde, Sebastian

AU - Checchia, Sergio L.

AU - Rowinski, Sergio

AU - Dodds, Seth

AU - Hurwit, Shep

AU - Sprengel, K.

AU - Van Der Stappen, W. A H

AU - Kronlage, Steve

AU - Beldner, Steven

AU - McCabe, Steven J.

AU - Morgan, Steven J.

AU - Rhemrev, Steven J.

AU - Hilliard, Stuart

AU - Gosens, Taco

AU - Sasaki, Takashi

AU - Taleb, C.

AU - Pritsch, Tamir

AU - Tosounidis, Theodoros

AU - Wyrick, Theresa

AU - DeCoster, Thomas

AU - Dienstknecht, Thomas

AU - Stackhouse, Thomas G.

AU - Hughes, Thomas

AU - Wright, Thomas

AU - Ly, Thuan V.

AU - Havenhill, Timothy G.

AU - Omara, Timothy

AU - Siff, Todd

AU - McLaurin, Toni M.

AU - Wanich, Tony

AU - Rueger, Johannes M.

AU - Vallim, Frederico C M

AU - Sabesan, Vani J.

AU - Nikolaou, Vasileios S.

AU - Verhofstad,

AU - Knoll, Victoria D.

AU - Telang, Vidyadhar

AU - Iyer, Vishwanath M.

AU - Jokhi, Vispi

AU - Batson, W. Arnnold

AU - Willems, W. Jaap

AU - Smith, Wade R.

AU - Belangero, William Dias

AU - Wolkenfelt, J.

AU - Weil, Yoram

PY - 2013/6

Y1 - 2013/6

N2 - Purpose To address the factors that surgeons use to decide between 2 options for treatment when the evidence is inconclusive. Methods We tested the null hypothesis that the factors surgeons use do not vary by training, demographics, and practice. A total of 337 surgeons rated the importance of 7 factors when deciding between treatment and following the natural history of the disease and 12 factors when deciding between 2 operative treatments using a 5-point Likert scale between 'very important' and 'very unimportant.' Results According to the percentages of statements rated very important or somewhat important, the most popular factors influencing recommendations when evidence is inconclusive between treatment and following the natural course of the illness were 'works in my hands,' 'familiarity with the treatment,' and 'what my mentor taught me.' The most important factors when evidence shows no difference between 2 surgeries were 'fewer complications,' 'quicker recovery,' 'burns fewer bridges,' 'works in my hands' and 'familiarity with the procedure.' Europeans rated 'works in my hands' and 'cheapest/most resourceful' of significantly greater importance and 'what others are doing,' 'highest reimbursement,' and 'shorter procedure' of significantly lower importance than surgeons in the United States. Observers with fewer than 10 years in independent practice rated 'what my mentor taught me,' 'what others are doing' and 'highest reimbursement' of significantly lower importance compared to observers with 10 or more years in independent practice. Conclusions Surgeons deciding between 2 treatment options, when the evidence is inconclusive, fall back to factors that relate to their perspective and reflect their culture and circumstances, more so than factors related to the patient's perspective, although this may be different for younger surgeons. Clinical relevance Hand surgeons might benefit from consensus fallback preferences when evidence is inconclusive. It is possible that falling back to personal comfort makes us vulnerable to unhelpful commercial and societal influences.

AB - Purpose To address the factors that surgeons use to decide between 2 options for treatment when the evidence is inconclusive. Methods We tested the null hypothesis that the factors surgeons use do not vary by training, demographics, and practice. A total of 337 surgeons rated the importance of 7 factors when deciding between treatment and following the natural history of the disease and 12 factors when deciding between 2 operative treatments using a 5-point Likert scale between 'very important' and 'very unimportant.' Results According to the percentages of statements rated very important or somewhat important, the most popular factors influencing recommendations when evidence is inconclusive between treatment and following the natural course of the illness were 'works in my hands,' 'familiarity with the treatment,' and 'what my mentor taught me.' The most important factors when evidence shows no difference between 2 surgeries were 'fewer complications,' 'quicker recovery,' 'burns fewer bridges,' 'works in my hands' and 'familiarity with the procedure.' Europeans rated 'works in my hands' and 'cheapest/most resourceful' of significantly greater importance and 'what others are doing,' 'highest reimbursement,' and 'shorter procedure' of significantly lower importance than surgeons in the United States. Observers with fewer than 10 years in independent practice rated 'what my mentor taught me,' 'what others are doing' and 'highest reimbursement' of significantly lower importance compared to observers with 10 or more years in independent practice. Conclusions Surgeons deciding between 2 treatment options, when the evidence is inconclusive, fall back to factors that relate to their perspective and reflect their culture and circumstances, more so than factors related to the patient's perspective, although this may be different for younger surgeons. Clinical relevance Hand surgeons might benefit from consensus fallback preferences when evidence is inconclusive. It is possible that falling back to personal comfort makes us vulnerable to unhelpful commercial and societal influences.

KW - Decision making

KW - Evidence-based medicine

KW - Treatment

UR - http://www.scopus.com/inward/record.url?scp=84878247647&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84878247647&partnerID=8YFLogxK

U2 - 10.1016/j.jhsa.2013.02.032

DO - 10.1016/j.jhsa.2013.02.032

M3 - Article

C2 - 23647639

AN - SCOPUS:84878247647

VL - 38

SP - 1202

EP - 1208

JO - Journal of Hand Surgery

JF - Journal of Hand Surgery

SN - 0363-5023

IS - 6

ER -