Regret in Surgical Decision Making: A Systematic Review of Patient and Physician Perspectives
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Regret is a powerful motivating factor in medical decision making among patients and surgeons. Regret can be particularly important for surgical decisions, which often carry significant risk and may have uncertain outcomes. We performed a systematic review of the literature focused on patient and physician regret in the surgical setting.
A search of the English literature between 1986 and 2016 that examined patient and physician self-reported decisional regret was carried out using the MEDLINE/PubMed and Web of Science databases. Clinical studies performed in patients and physicians participating in elective surgical treatment were included.
Of 889 studies identified, 73 patient studies and 6 physician studies met inclusion criteria. Among the 73 patient studies, 57.5% examined patients with a cancer diagnosis, with breast (26.0%) and prostate (28.8%) cancers being most common. Interestingly, self-reported patient regret was relatively uncommon with an average prevalence across studies of 14.4%. Factors most often associated with regret included type of surgery, disease-specific quality of life, and shared decision making. Only 6 studies were identified that focused on physician regret; 2 pertained to surgical decision making. These studies primarily measured regret of omission and commission using hypothetical case scenarios and used the results to develop decision curve analysis tools.
Self-reported decisional regret was present in about 1 in 7 surgical patients. Factors associated with regret were both patient- and procedure related. While most studies focused on patient regret, little data exist on how physician regret affects shared decision making.
KeywordsRadical Prostatectomy Biliary Tract Cancer Anticipate Regret Decisional Regret Decision Curve Analysis
Compliance with ethical standards
Conflict of interest
- 2.Legare F, Ratte S, Stacey D et al (2010) Interventions for improving the adoption of shared decision making by healthcare professionals. Cochrane Database Syst Rev. doi: 10.1002/14651858.CD006732.pub3
- 43.Hacking B, Wallace L, Scott S, Kosmala-Anderson J, Belkora J, McNeill A (2013) Testing the feasibility, acceptability and effectiveness of a ‘decision navigation’ intervention for early stage prostate cancer patients in Scotland–a randomised controlled trial. Psycho-oncology 22(5):1017–1024CrossRefPubMedGoogle Scholar
- 44.Good DW, Delaney H, Laird A, Hacking B, Stewart GD, McNeill SA (2015) Consultation audio-recording reduces long-term decision regret after prostate cancer treatment: a non-randomised comparative cohort study. Surg J R Coll Surg Edinb Irel 14(6):308–314Google Scholar
- 50.Ejaz A, Kim Y, Winner M et al (2016) Associations between patient perceptions of communication, cure, and other patient-related factors regarding patient-reported quality of care following surgical resection of lung and colorectal cancer. J Gastrointest Surg 20(4):812–826CrossRefPubMedGoogle Scholar
- 77.Blumenthal-Barby JS, Kostick KM, Delgado ED et al (2015) Assessment of patients’ and caregivers’ informational and decisional needs for left ventricular assist device placement: implications for informed consent and shared decision-making. J Heart Lung Transplant 34(9):1182–1189CrossRefPubMedGoogle Scholar