October's Paper of the Month reports on patient experience of shared decision making (SDM) and decision regret following surgical management of pilonidal disease.
Decision regret following surgical management of pilonidal disease
Banks J, Lee E, Lee MJ, Brown SR, Colorectal Disease Journal, 2024
What is known about the subject?
Pilonidal disease (PD) commonly affects young adults, especially men, significantly impacting their personal and social lives. The surgical treatment for PD varies widely, and there is no consensus on the optimal approach. Traditional excisional procedures often result in lengthy recovery times and complications, whereas minimally invasive techniques may lead to higher recurrence rates. There is a growing interest in how shared decision-making between surgeons and patients affects outcomes, particularly regarding postoperative satisfaction and decision regret.
What the study adds?
The study, a subanalysis of the PITSTOP cohort, evaluated 677 patients who underwent surgery for pilonidal disease between 2019 and 2022. It explored the relationship between shared decision-making and decision regret six months post-surgery. Most patients (59.5%) had major excisional procedures, with a 45% complication rate. Despite these challenges, patient satisfaction with shared decision-making was high, and overall decision regret was low. However, patients who underwent a 'leave open' procedure were more likely to experience dissatisfaction due to prolonged wound healing and recovery.
Postoperative complications and disease recurrence were the primary factors contributing to decision regret. Linear regression analysis indicated that complications and recurrence significantly impacted regret. The study suggests that while shared decision-making is effective, clinical outcomes, especially postoperative complications, are vital for determining patient satisfaction.
Implications for surgical practice
Surgical choices: Although associated with a higher risk of recurrence, minimally invasive procedures usually offer faster recovery and lower complication rates. In contrast, major excisional surgeries tend to have more prolonged recovery, with a higher risk of complications but potentially lower recurrence rates.
Shared decision-making and patient-centred care: Surgeons should engage patients in shared decision-making to align treatment with their preferences. Given the significant impact of postoperative complications on patient regret, surgeons should thoroughly discuss risks, benefits, and possible complications with patients to manage realistic expectations. This may help reduce decision regret, even when clinical outcomes are suboptimal.
Take-home message
Complications and the recurrence of disease are major factors contributing to decision regret among patients with pilonidal disease following surgery. This highlights the importance of shared decision-making in surgical practices. Although patient satisfaction with the shared decision-making process is generally high, clinical outcomes, especially complication rates, are pivotal in reducing regret and enhancing long-term patient satisfaction.
