WP7.15 - Surgical dogma… Why change?

Abstract

Abstract Aims Surgical dogma still persists today despite up-to-date evidence. Implementation of evidence into clinical practice takes on average 17 years. Acute appendicitis is typically managed with surgery, despite evidence recommending a non-operative, antibiotic-only strategy as an appropriate first line treatment in uncomplicated cases. This study investigates barriers to, and facilitators of, changing practice with regards to management of acute appendicitis. Methods Surgeons involved in emergency general surgery in U.K. hospitals were invited to participate in online/telephone semi-structured interviews. Thematic analysis based on the theoretical domains framework was used to develop belief statements. Results 16 interviews were conducted to achieve data saturation. 8 consultant surgeons, 8 surgical trainees from secondary and tertiary centres participated. Numerous barriers and facilitators were identified. There is a lack of awareness of current research with variable interpretation of evidence and its practical applications. There were concerns regarding loss of training opportunities in a “benchmark” procedure; failure of treatment and subsequent complications; missed malignancy and cost implications. Surgeons identified a reluctance to change from long standing practice and recognised their communication may skew patients’ decision making. Decision making practice varied from paternalistic to shared/supported. Surgeons believe they undertake a fully informed consent process, despite some not offering non-operative management as an alternative treatment. Conclusions Numerous barriers and facilitators exist to implementing change and are often based on surgeons’ personal experiences rather than evidence. The identified factors will be used to develop an implementation strategy to drive evidence-based practice and may be transferable to other surgical conditions.