J. C. Apfeld1,2,3, J. N. Cooper1,2,3, P. C. Minneci1,2,3, K. J. Deans1,2,3 1Nationwide Children’s Hospital,General Pediatric Surgery,Columbus, OH, USA 2Nationwide Children’s Hospital,Center For Innovation In Pediatric Practice,Columbus, OH, USA 3Nationwide Children’s Hospital,Center For Surgical Outcomes Research,Columbus, OH, USA
Introduction:
Non-operative management with antibiotics alone is increasingly being offered as an alternative treatment to urgent surgery for uncomplicated appendicitis. Shared decision making between these two treatments may be facilitated by having a better understanding of how patients and their caregivers value specific risks and benefits of each treatment and how those values relate to their treatment decision. The objective of this study is to examine differences in values regarding the risks and benefits of each treatment option between patient-caregiver dyads who chose surgery vs. nonoperative management for their child’s appendicitis.
Methods:
As part of a completed randomized clinical trial, we developed a tablet-based values exercise that allowed patients and caregivers to rate the importance of eight treatment-related risks/benefits of surgery vs. non-operative management for uncomplicated appendicitis using a 5-point Likert scale. Patients-caregiver dyads completed this exercise and subsequently chose either surgery or non-operative management for their child’s appendicitis. Value scores were compared based on the treatment decision using Cochran-Armitage tests for trend.
Results:
Of the 96 participants with available data, 69% (n=66) chose surgery and 31% (n=30) chose nonoperative management. There were no significant differences between participants choosing surgery or non-operative management in levels of education, income, employment, marital status, or predominant language spoken at home; however, patient-caregivers choosing surgery were more likely to have been transferred from another institution. Mean value scores for each treatment-related risk/benefit according to treatment choice are shown in the figure. In the group choosing surgery, the highest three priorities were avoiding recurrence of appendicitis, avoiding risks of bleeding and infection, and avoiding side effects from antibiotics (mean scores=4.8, 4.2, and 3.5 respectively). In the non-operative group, the two highest priorities were the same with the third being avoiding an operation for appendicitis (mean scores=4.7, 4.7, and 4.1 respectively).
Conclusion:
The relative importance of treatment-related risks and benefits differed between patients and caregivers choosing surgery vs. non-operative management. However, the two most important treatment-related risks/benefits were the same in both groups. This suggests that that the associated risks and benefits of each treatment are subjectively interpreted and valued by individual patients and their caregivers. These results support the need for shared decision making with patients and their caregivers when deciding on the treatment for uncomplicated appendicitis.
