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Clinician factors influencing decision-making in emergency general surgery (EGS): a scoping review protocol

Por: Groundwater · E. · Bisset · C. N. · Bradley · R. · John-Charles · R. · Maeda · Y. · McKee · T. · Moug · S. J.
Introduction

Emergency general surgery (EGS) decisions often occur under time pressure and with reduced patient involvement in comparison to the elective setting. Variation in decision-making in the field of EGS is partly attributable to patient and contextual factors, but clinician factors also likely shape decisions.

This scoping review aims to clarify which clinician factors have been investigated in relation to decision-making in adult EGS, which have been identified as influential, and the methods used to measure them.

Methods and analysis

Any studies reporting on individual clinician factors and decision-making in EGS will be eligible. Studies must be only in adult populations (patients aged 18 and over). This review will consider quantitative, qualitative and mixed-methods study designs.

This scoping review will be conducted in accordance with the methodology developed by the Joanna Briggs Institute and reported in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. This protocol was prospectively registered with the Open Science Framework: https://osf.io/xcqp4. We will search MEDLINE, EMBASE, CINAHL, CDSR and CENTRAL. The search strategy will be adapted for each database, and no time or language restrictions will be applied.

Two independent reviewers will screen studies for eligibility and extract data using a purpose-designed data extraction form, with disagreements resolved by a third reviewer. Extracted data will be synthesised using a narrative approach to map key concepts, describe study characteristics and identify gaps in the literature.

Ethics and dissemination

Ethical approval is not required as this review will use publicly available data. Findings will be disseminated through peer-reviewed publication and conference presentations.

The clinical application of shared decision-making in emergency surgery: a scoping review protocol

Por: Bisset · C. N. · Keane · C. · McKee · T. · John-Charles · R. · Wells · C. I. · Moug · S. J.
Introduction

Shared decision-making (SDM) between clinicians and patients is considered ‘best practice’. There is limited evidence regarding SDM in surgery, particularly in the emergency setting. Emergency SDM may be particularly challenging due to: time pressures, the patient’s underlying condition and the nature of the patient-surgeon interaction. However, emergency surgery arguably has a greater need for SDM due to the likelihood of disparate outcomes from intervention, which is dependent on the various treatment options available. This is necessary for patients to make informed decisions regarding their treatment of surgical pathology. The primary objective of this scoping review is to understand the extent and type of evidence in relation to SDM in emergency surgery to determine methods for improving SDM.

Methods

Any studies reporting SDM in emergency surgery on adult patients (age >18 years) will be included. EMBASE, Medline, Cochrane, CINAHL and Scopus databases will be searched for articles with no language or date limits. Studies will be screened by two independent reviewers, with consensus met prior to data extraction. Data extracted to include study design, details of study population, tools used to measure SDM, prevalence of SDM and barriers and enablers for SDM.

A systematic narrative synthesis will be performed following JBI (Joanna Briggs Institute) guidance. These will summarise findings of included studies. The findings may inform future research into facilitating implementation of SDM in emergency surgery.

Ethics and dissemination

This study does not require ethical approval. Final findings will be submitted for peer-reviewed publication and presentation at surgical conferences.

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