BookMark K. Ferguson, editor.
Summary: This updated volume provides a practical guide to decision making within thoracic surgery. Focussed chapters contain pithy analyses and recommendations that allow useful information to be identified at a glance. All new chapters bring insight into the challenges faced operating on the lung, esophagus, diaphragm, airway, pleaura, mediastinum, and chest wall. Difficult Decisions in Thoracic Surgery aims to help the reader navigate the complexities of thoracic surgery through clearly formatted and evidence-based chapters. The book is relevant to practicing and trainee surgeons, as well as medical professionals working within thoracic surgery.
Contents:
Intro
Preface to the First Edition
Preface to the Fourth Edition
Contents
1: Introduction
Introduction
Early Surgical Decision Making
Evidence-Based Surgical Decisions
The Age of Information
The Age of Data
What Lies in the Future?
Conclusion
References
2: Evidence Based Medicine: Quality of Evidence and Evaluation Systems
Introduction
The GRADE Approach
Defining the Clinical Question
What Outcomes Should We Consider for Clinical Decision Making?
Grading the Quality of Evidence Rating the Quality of Evidence from Randomized Controlled Trials
Limitations in Study Design
Inconsistency of Study Results
Indirectness of Evidence
Imprecision
Publication Bias
Rating Up the Quality of Evidence from Observational Studies
Moving from Quality of Evidence to Formulating Recommendations
Resource Use
Presenting Summary of Findings
How Should Clinical Guidance Be Worded?
Applying GRADE
Conclusion
References
3: Decision Analytic Techniques and Other Decision Processes
Introduction
Application of Decision Analytic Techniques Action Versus Inaction
Choice Among Various Actions That Seem Plausible
Optimizing Timing or Interval of Action
Technical Aspects
P: Problem(s)-Define Problem Explicitly
R: Reframe
O: Objective-Focus on the Objective(s)
A: Alternatives
C: Consequences/Chances
T: Trade-Offs
I: Integrate
V: Value
E: Explore/Evaluate
Creating a Decision Tree
Special Situations
Cost-Effectiveness Analysis (CEA)
Markov Modeling
Other Clinical Applications of Decision Analysis
Healthcare Policy
Clinical Protocols
Patient Decision Aids Benefits of Decision Analysis
Drawbacks and Limitations of Decision Analysis
Conclusion
References
4: Decision Making: The Surgeon's Perspective
Introduction
Models of the Surgeon-Patient Relationship
Methodology for Evaluating Decision-Making Factors
Surgeon Factors Related to Clinical Decision-Making
Impact of Risk-Taking Attitude on Clinical Decision-Making
Impact of Surgeon Age
Impact of Surgeon Gender
Impact of Specialty Training
Healthcare System Factors Related to Clinical Decision Making
Impact of Practice Environment Impact of Political Environment
Impact of the Medico-Legal Environment
Summary
References
5: Involving Patients in Difficult Decisions About Having Surgery
Introduction
What Is Shared Decision Making?
Call for Shared Decision Making
Meeting the Requirement of Informed Patients in SDM
Impact of SDM on Clinical Outcomes
The Need for SDM in Surgical Care
Problems with SDM and Surgery
Patient Clinical Complexity
Difficulties in Patient Comprehension
Surgical Practice
The Way Forward
Summary
References
Part I: Lung