Skip to main content
SpringerLink
Log in

To operate or not—the impact of a lecture on radical glioblastoma surgery and different treatment options on decision-making for oneself and patients

  • Clinical Article - Brain Tumors
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Clinical decision-making involves a complex interaction between patients and caregivers. The medical knowledge and values of caregivers are essential for treatment recommendations. This study was undertaken to evaluate treatment recommendations by a group of Scandinavian neurosurgeons before and after an expert lecture on glioblastoma surgery.

Method

An interactive voting system was used to record responses to four questions regarding glioblastoma management before and after a 25-min lecture on the benefit of radical glioblastoma surgery.

Results

The majority of the audience aimed at radical surgery combined with radiotherapy before (76 %) and after (88 %) the lecture. The proportion who recommended immediate postoperative follow-up by MRI increased from 34 % to 75 %. Fourteen percent (before) and 45 % (after) recommended renewed surgery to remove small residuals in patients, while 52 % (before) and 60 % (after) would have wanted to be re-operated if they themselves had been patients.

Conclusion

The views on optimum management differed widely in a relatively homogeneous group of neurosurgeons. The lecture had a major impact on decision-making. A large proportion of the attendees recommended different management strategies for themselves and for their patients. The findings indicated the need to analyze the evaluation of medical knowledge, discuss the ethics of decision-making and encourage second opinions for serious neurosurgical decisions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Sackett DL, Rosenberg WC, Muir Gray JA, Haynes RB, Richardson WS (1996) Evidence based medicine: what it is and what it isn’t. BMJ 312:70–72

    Article  Google Scholar 

  2. Bate L, Hutchinson A, Underhill J, Maskrey N (2012) How clinical decisions are made. Br J Clin Pharmacol 74:614–620

    Article  PubMed  Google Scholar 

  3. Kanu OO, Mehta A, Di C, Lin N, Bortoff K, Bigner DD, Yan H, Adamson DC (2009) Glioblastoma multiforme: a review of therapeutic agents. Expert Opin Ther Targets 13:701–718

    Article  PubMed  CAS  Google Scholar 

  4. World Value Survey (1998) In: Inglehart R, Basañez M, Moreno A (eds) Human values and beliefs—source book. University of Michigan Press, Chicago

    Google Scholar 

  5. Metcalfe SE, Grant R (2001) Biopsy versus resection for malignant glioma. Cochrane Database Syst Rev 2001(3), CD002034

    Google Scholar 

  6. Haack S (2003) Defending science—within reason. Prometheus Books, New York

  7. British Medical Association (1995) Report of the working party on medical education. BMA, London

    Google Scholar 

  8. Marshall T (1995) Evidence based medicine. Lancet 346:1171–1172

    Article  PubMed  CAS  Google Scholar 

  9. Editorial, no authors listed (1995) Evidence based medicine; in its place. Lancet 346:785

    Article  Google Scholar 

  10. Sackett DL (1995) Surveys of self-reported reading times of consultants in Oxford, Birmingham, Milton-Keynes, Bristol, Leicester, and Glasgow. In: Rosenberg WMC, Richardson WS, Haynes RB, Sackett DL (eds) Evidence-based medicine. Churchill Livingstone, London

    Google Scholar 

  11. Cohen AM, Hersh WR (2004) Criticisms of evidence—based medicine. Evid Based Cardiovasc Med 8:197–198

    Article  PubMed  Google Scholar 

  12. Popper K (1962) Conjectures and refutations. Routledge and Keagan Paul, London

    Google Scholar 

  13. Davidoff F, Haynes B, Sackett D, Smith R (1995) Evidence based medicine: a new joumal to help doctors identify the information they need. BMJ 310:1085–1086

    Article  PubMed  CAS  Google Scholar 

  14. Goldenberg MJ (2006) On evidence and evidence-based medicine: lessons from the philosophy of science. Soc Sci Med 62:2621–2632

    Article  PubMed  Google Scholar 

  15. Weatherall DJ (1994) The inhumanity of medicine. BMJ 309:1671–1672

    Article  PubMed  CAS  Google Scholar 

  16. Kuhn T (1996) The structure of scientific revolutions, 3rd edn. University of Chicago Press, Chicago

    Book  Google Scholar 

  17. Popper K (1959) The logic of scientific discovery. Routledge, London

    Google Scholar 

  18. Worrall J (2007) Evidence in medicine and evidence-based medicine. Philos Compass 2/6:981–1022

    Article  Google Scholar 

  19. Tännsjö T (2002) Understanding ethics. An introduction to moral theory. Edinburgh University Press, Edinburgh

    Google Scholar 

Download references

Acknowledgment

We acknowledge the expert lecture given by Prof. Manfred Westphal, which was indispensible for our study.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Karolinska Hospital, 171 76, Stockholm, Sweden

    Tiit Mathiesen

  2. Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden

    Tiit Mathiesen

Authors
  1. Tiit Mathiesen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tiit Mathiesen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mathiesen, T. To operate or not—the impact of a lecture on radical glioblastoma surgery and different treatment options on decision-making for oneself and patients. Acta Neurochir 155, 1425–1429 (2013). https://doi.org/10.1007/s00701-013-1796-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-013-1796-8

Keywords

Search

Navigation