Decision-making in rectal and colorectal cancer: systematic review and qualitative analysis of surgeons’ preferences

Abstract

Surgeons are experiencing difficulties implementing recommendations not only owing to incomplete, confusing or conflicting information but also to the increasing involvement of patients in decisions relating to their health. This study sought to establish which common factors including heuristic factors guide surgeons’ decision-making in colon and rectal cancers. We conducted a systematic literature review of surgeons’ decision-making factors related to colon and rectal cancer treatment. Eleven of 349 identified publications were eligible for data analyses. Using the IRaMuTeQ (Interface of R for the Multidimensional Analyses of Texts and Questionnaire), we carried out a qualitative analysis of the significant factors collected in the studies reviewed. Several validation procedures were applied to control the robustness of the findings. Five categories of factors (i.e. patient, surgeon, treatment, tumor and organizational cues) were found to influence surgeons’ decision-making. Specifically, all decision criteria including biomedical (e.g. tumor information) and heuristic (e.g. surgeons’ dispositional factors) criteria converged towards the factor ‘age of patient’ in the similarity analysis. In the light of the results, we propose an explanatory model showing the impact of heuristic criteria on medical issues (i.e. diagnosis, prognosis, treatment features, etc.) and thus on decision-making. Finally, the psychosocial complexity involved in decision-making is discussed and a medico-psycho-social grid for use in multidisciplinary meetings is proposed.

Keywords:

• Decision-making factors
• psychosocial complexity
• qualitative review
• implementation of guidelines

Notes

1. With the following request: (((decision[Title] OR deliberation[Title] OR choice[Title] OR verdict[Title] OR judg*[Title]) AND (rect* OR colorect* OR bowel)) AND cancer) NOT screen*[Title].

2. With the following request: TI ( decision OR deliberation OR choice OR verdict OR judg* ) AND ( rect* OR colorect* OR bowel ) AND cancer NOT TI screen*.

3. The software is available on the official website http://www.iramuteq.org/ and requires downloading the free R software at the link https://www.r-project.org/.

4. According to the author, items of information are basically structured around a socially shared, rigid and stable hub of knowledge (i.e. the central core of representation), and certain contextual varying data (i.e. the peripheral elements of representation).

5. The judge selection method allows the researcher to make choices or to lend weight to his/her own subjective decisions by obtaining an inter-coder rate of agreement.