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A qualitative study exploring risk perception in congenital cardiac surgery: the perspective of UK surgeons

Published online by Cambridge University Press:  14 May 2021

Robyn R Lotto Open the ORCID record for Robyn R Lotto [Opens in a new window] ,
Sarah E Seaton ,
Ian D Jones  and
Attilio A Lotto
Robyn R Lotto*
Affiliation:
Liverpool John Moores University, Liverpool, United Kingdom
Sarah E Seaton
Affiliation:
University of Leicester, Leicester, United Kingdom
Ian D Jones
Affiliation:
Liverpool John Moores University, Liverpool, United Kingdom
Attilio A Lotto
Affiliation:
Liverpool John Moores University, Liverpool, United Kingdom Alder Hey Children’s NHS Trust, Liverpool, United Kingdom
*
Author for correspondence: Dr Robyn Lotto, Liverpool John Moores University, Tithebarn Street, Liverpool John, Liverpool, United Kingdom. Tel: 0151 231 2121. E-mail r.r.lotto@ljmu.acuk
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Abstract

Introduction:

Managing risk is central to clinical care, yet most research focuses on patient perception, as opposed to how risk is enacted within the clinical setting by healthcare professionals.

Aim:

To explore how surgical risk is perceived, encountered, and managed by congenital cardiac surgeons.

Methods:

Semi-structured interviews were conducted with 20 congenital cardiac surgeons representing every unit across England and Wales. All interviews were transcribed verbatim, with analysis based on the constant comparative approach.

Findings:

Three themes were identified, reflecting the interactions between personal, institutional, and political context in which risk is encountered and managed. First, “communicating risk” highlights the complexity and variability in methods employed by surgeons to balance legal/moral obligations with parental need and expectations. Universally, surgeons described the need for flexibility in their approach in order to meet the needs of individual patients. Second, “scrutiny and accountability” captures the spectrum of opinion arising from the binary nature of the outcomes collated and the way in which they are perceived to be interpreted. Third, “nature of the job” highlights the personal and professional implications of conveying and managing risk and the impact of recent policy changes on the way this is enacted.

Conclusion:

Variations in approaches to communicating risk demonstrate a lack of consensus, compounded by insufficient evidence to determine or monitor a “best-care” approach. With current surgical outcomes suggesting little room for increasing survival rates, future care needs should shift to the “soft skills” in order to continue to drive improvements in parental and patient experience.

Keywords

Congenital cardiac surgeryqualitativecongenital heart diseaserisk perception
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 2 , February 2022 , pp. 208 - 214
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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References

Fox, R Medical uncertainty revisited. In: Bird, C, Conrad, P, Freemont, A, (eds). Handbook of Medical Sociology. Prentice Hall, New Jersey, 2000: 416.Google Scholar
Breakwell, GM, Jodelet, D, Vala, J, et al Societies under threat: A pluri-disciplinary approach. 2020.Google Scholar
Slovic, P The perception of risk. Routledge, Oxford, 2016.CrossRefGoogle Scholar
Kahneman, D, Tversky, A Thinking Fast, Thinking Slow. Macmillan, Germany, 2011.Google Scholar
Bogardus, ST Jr, Holmboe, E, Jekel, JF Perils, pitfalls, and possibilities in talking about medical risk. JAMA 1999; 281: 1037–1041.CrossRefGoogle ScholarPubMed
Paton, A, Armstrong, N, Smith, L, Lotto, R Parents’ decision-making following diagnosis of a severe congenital anomaly in pregnancy: practical, theoretical and ethical tensions. Soc Sci Med 2020:113362.CrossRefGoogle ScholarPubMed
Spiegelhalter, D, Pearson, M, Short, I Visualizing uncertainty about the future. Science 2011; 333(6048): 1393–1400.CrossRefGoogle ScholarPubMed
Lotto, R, Jones, I, Seaton, SE, et al. Congenital cardiac surgery and parental perception of risk: a quantitative analysis. World J Pediatr Congenit Heart Surg 2019; 10: 669–677.CrossRefGoogle ScholarPubMed
Lotto, RR, Jones, ID, Guerrero, R, et al. Congenital cardiac surgery and parental perception of risk: a qualitative study. Cardiol Young 2019; 29: 1361–1367.CrossRefGoogle ScholarPubMed
Dixon-Woods, M, Yeung, K, Bosk, CL Why is UK medicine no longer a self-regulating profession? The role of scandals involving “bad apple” doctors. Soc Sci Med 2011; 73: 1452–1459.CrossRefGoogle ScholarPubMed
Kennedy, I Bristol Royal Infirmary Inquiry; Learning from Bristol: The Report of the Public Inquiry into Children’s Heart Surgery at the Bristol Royal Infirmary 1984–1995. The Stationary Office, London, 2001.Google Scholar
Pagel, C, Utley, M, Crowe, S, et al. Real time monitoring of risk-adjusted paediatric cardiac surgery outcomes using variable life-adjusted display: implementation in three UK centres. Heart 2013; 99: 1445–1450.CrossRefGoogle ScholarPubMed
Elliott, M 19 Lessons Learned from the Public Inquiry into Children’s Heart. Pediatric and Congenital Cardiac Care: Volume 2: Quality Improvement and Patient Safety 2014: 243.CrossRefGoogle Scholar
Elliott, M Lessons Learned from the Public Inquiry into Children’s Heart Surgery at the Bristol Royal Infirmary and the English Safe and Sustainable Cardiac Review. Pediatric and Congenital Cardiac Care: Springer, 2015:243–59.CrossRefGoogle Scholar
Dyer, C Suspension of paediatric heart surgery in Leeds provokes controversy. BMJ 2013; 346: f2098.Google ScholarPubMed
Francis, J, Johnston, M, Robertson, C, et al. What is an adequate sample size? Operationalising data saturation for theory-based interview studies. Psychol Health 2010; 25: 1229–1245.CrossRefGoogle ScholarPubMed
Strauss, A, Corbin, J Basics of qualitative research: Grounded theory procedures and techniques. Sage, Newbury Park, California, 1990.Google Scholar
Katz, P The scalpel’s edge: The culture of surgeons. 1999.Google Scholar
Hussein, N, Honjo, O, Haller, C, et al. Hands-on surgical simulation in congenital heart surgery: literature review and future perspective. In: Conference Hands-on surgical simulation in congenital heart surgery: literature review and future perspective, 2020, pp. 98–105. Elsevier.Google Scholar
Department of Health (DoH). Reference guide to consent for examination or treatment. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/138296/dh_103653__1_.pdf 20-01-2020).Google Scholar
Haywood, N, Kron, IL Commentary: litigation risk in congenital cardiac surgery. J Cardiac Surg; 36: 143–144.CrossRefGoogle Scholar
Lotto, R, Smith, LK, Armstrong, N Diagnosis of a severe congenital anomaly: A qualitative analysis of parental decision making and the implications for healthcare encounters. Health Expect 2018; 21: 678–684.CrossRefGoogle ScholarPubMed
Pfeil, M Parents’ experience of giving consent for their child to undergo surgery. J Child Health Care 2011; 15: 380–388.CrossRefGoogle ScholarPubMed
Blumenthal-Barby, JS, Krieger, H Cognitive biases and heuristics in medical decision making: a critical review using a systematic search strategy. Med Decis Making 2015; 35: 539–557.CrossRefGoogle ScholarPubMed
Redelmeier, D, Rozin, P, Kahneman, D Understanding patients’ decisions: cognitive and emotional perspectives. JAMA 1993; 270(1): 72–76.CrossRefGoogle ScholarPubMed
Faden, RR, Beauchamp, TL A history and theory of informed consent. Oxford University Press, 1986.Google Scholar
Mamede, S, de Carvalho-Filho, MA, de Faria, RMD, et al. ‘Immunising’physicians against availability bias in diagnostic reasoning: a randomised controlled experiment. BMJ Qual Safety 2020; 29: 550–559.CrossRefGoogle ScholarPubMed
Kahneman, D, Lovallo, D, Sibony, O Before you make that big decision. Harv Bus Rev 2011; 89: 50–60, 137.Google ScholarPubMed
Exworthy, M, Gabe, J, Jones, IR, Smith, G Professional autonomy and surveillance: the case of public reporting in cardiac surgery. Sociol Health Illn 2019; 41: 1040–1055.CrossRefGoogle ScholarPubMed
Lilford, R, Pronovost, P Using hospital mortality rates to judge hospital performance: a bad idea that just won’t go away. Bmj 2010; 340: c2016.CrossRefGoogle ScholarPubMed
Hawkins, RB, Mehaffey, JH, Chancellor, WZ, et al. Risk aversion in cardiac surgery: 15-year trends in a statewide analysis. Ann Thorac Surg 2020; 109: 1401–1407.CrossRefGoogle Scholar
Karl, TR, Jacobs, JP Paediatric cardiac surgical education: which are the important elements? Cardiol Young 2016; 26: 1465–1470.CrossRefGoogle ScholarPubMed
Lotto, A Congenital Cardiac Surgery Workforce. Unpublished audit 2020.Google Scholar
Jonas, RA Training fellows in paediatric cardiac surgery. Cardiol Young 2016; 26: 1474–1483.CrossRefGoogle ScholarPubMed
NHS England. New Congenital Heart Disease Standards. 2015. Accessed 03–02–2021.Google Scholar
Dyer, C Shortcomings in cardiac unit at St George’s hospital linked to 67 deaths. BMJ 2020; 368: m1281.Google ScholarPubMed
Hagelsteen, K, Johansson, B-M, Bergenfelz, A, Mathieu, C Identification of Warning Signs During Selection of Surgical Trainees. J Surg Educ 2019; 76: 684–693.CrossRefGoogle ScholarPubMed
Dimou, FM, Eckelbarger, D, Riall, TS Surgeon burnout: a systematic review. J Am Coll Surg 2016; 222: 1230.CrossRefGoogle ScholarPubMed