Surgical Decisions in Spontaneous Intracerebral Hemorrhage
Surgical Decisions in Spontaneous Intracerebral Hemorrhage
Decision making for patients with spontaneous intracerebral hemorrhage (ICH) poses several challenges. Outcomes in this patient population are generally poor, prognostication is often uncertain, and treatment strategies offer limited benefits. Studies demonstrate variability in the type and intensity of treatment offered, which is attributed to clinical uncertainty and habits of training. Research has focused on new techniques and more stringent evidence-based selection criteria to improve outcomes and produce consensus around treatment strategies for patients with ICH. Such focus, however, offers little description of how ICH treatment decisions are made and how such decisions reflect patient preferences regarding medical care. A growing body of literature suggests that the process of decision making in ICH is laden with bias, value assumptions, and subjective impressions. Factors such as geography, cognitive biases, patient perceptions, and physician characteristics can all shape decision making and the selection of treatment. Such factors often serve as a barrier to providing patient-centered medical care. In this article, the authors review how surgical decision making for patients with ICH is shaped by these decisional factors and suggest future research pathways to study decision making in ICH. Such research efforts are important for establishing quality guidelines and pay-for-performance measures that reflect the preferences of individual patients and the contextual nature of medical decision making.
Samuel Johnson, The Rambler, No. 48 (1750)
Surgical decision making for patients with spontaneous ICH remains problematic. The benefits of intervention are unclear and intervention frequency and distribution are highly variable among countries, institutions, and individual physicians. Much of the clinical research targeting treatment for ICH presumes that improved techniques or better evidence-based selection criteria will build consensus around treatment decisions and reduce decisional uncertainty. These efforts, however, address only part of the problem.
A growing body of literature suggests that the process of clinical decision making has a profound impact on treatment decisions and patient outcomes. Factors affecting the decision-making process are multiple and include physician heuristics and biases, institutional practices, interpretation of disparate and sometimes conflicting medical evidence, and implementation of patient preferences. Improving care for patients with ICH requires an investigation of how neurosurgeons make treatment decisions, what biases and heuristics influence this process, and how this process relates to a patient's known wishes or anticipated desires concerning treatment. In this article, we explore the decisional factors related to management of patients with ICH and suggest future research pathways that may improve our understanding of how these factors influence treatment decisions and patient care.
Abstract and Introduction
Abstract
Decision making for patients with spontaneous intracerebral hemorrhage (ICH) poses several challenges. Outcomes in this patient population are generally poor, prognostication is often uncertain, and treatment strategies offer limited benefits. Studies demonstrate variability in the type and intensity of treatment offered, which is attributed to clinical uncertainty and habits of training. Research has focused on new techniques and more stringent evidence-based selection criteria to improve outcomes and produce consensus around treatment strategies for patients with ICH. Such focus, however, offers little description of how ICH treatment decisions are made and how such decisions reflect patient preferences regarding medical care. A growing body of literature suggests that the process of decision making in ICH is laden with bias, value assumptions, and subjective impressions. Factors such as geography, cognitive biases, patient perceptions, and physician characteristics can all shape decision making and the selection of treatment. Such factors often serve as a barrier to providing patient-centered medical care. In this article, the authors review how surgical decision making for patients with ICH is shaped by these decisional factors and suggest future research pathways to study decision making in ICH. Such research efforts are important for establishing quality guidelines and pay-for-performance measures that reflect the preferences of individual patients and the contextual nature of medical decision making.
Introduction
Disease generally begins that equality which death completes…where all human glory is obliterated, the wit is clouded, the reasoner perplexed, and the hero subdued…Samuel Johnson, The Rambler, No. 48 (1750)
Surgical decision making for patients with spontaneous ICH remains problematic. The benefits of intervention are unclear and intervention frequency and distribution are highly variable among countries, institutions, and individual physicians. Much of the clinical research targeting treatment for ICH presumes that improved techniques or better evidence-based selection criteria will build consensus around treatment decisions and reduce decisional uncertainty. These efforts, however, address only part of the problem.
A growing body of literature suggests that the process of clinical decision making has a profound impact on treatment decisions and patient outcomes. Factors affecting the decision-making process are multiple and include physician heuristics and biases, institutional practices, interpretation of disparate and sometimes conflicting medical evidence, and implementation of patient preferences. Improving care for patients with ICH requires an investigation of how neurosurgeons make treatment decisions, what biases and heuristics influence this process, and how this process relates to a patient's known wishes or anticipated desires concerning treatment. In this article, we explore the decisional factors related to management of patients with ICH and suggest future research pathways that may improve our understanding of how these factors influence treatment decisions and patient care.
