A recent article published in JAMA Surgery examines the values and opinions of patients about their preferred methods of treating acute appendicitis.
The appendix is a small organ connected to the large intestine that is widely believed to have no major function in our bodies. For reasons that are not clear, the lining of the appendix can get blocked, which results in an infection.Consequently, the appendix can become inflamed and swollen, a condition known as acute appendicitis, leading to symptoms such as nausea, abdominal pain, and bloating.
What is Appendicitis?
Acute appendicitis can be treated surgically or through other invasive procedures such as laparoscopy (a minimally invasive surgery requiring a small incision while using a tubular device) and percutaneous drainage. Uncomplicated appendicitis, on the other hand, can be treated with antibiotics alone. In many cases, multiple treatment options are available for each patient, and some doctors believe that patients’ values play a big role in determining which treatment to undertake.
Instead of physicians making treatment decisions without the input of patients, one group of doctors suggests that patients should be able to make the choice based on their own values. This group of American physicians therefore investigated how patients might choose treatment for acute appendicitis and recently published their findings in JAMA Surgery.
This study consisted of two parts: an online survey to gauge patient preferences for appendicitis treatment and then a follow-up, smaller-scale survey in person to more closely evaluate why patients would choose antibiotics as a treatment.
Most Patients Prefer Laparoscopic Appendectomy
A total of 1,728 individuals from 19 countries completed the online survey, which asked them to imagine if they had to undergo treatment for appendicitis. A majority of them (86%) would have preferred laparoscopic appendectomy, 5% preferred open appendectomy (invasive surgery), and only 9% preferred antibiotics. Unsurprisingly, those who chose antibiotics valued the avoidance of surgery and did not value quick treatment as much as other respondents.
Interestingly, analyses showed that those with more education were more likely to choose antibiotics. The study also showed that surgeons who were polled were more likely to choose open surgery over antibiotics or laparoscopy compared to non-surgeons. Moreover, when the question was posed for children’s treatment, respondents were slightly more likely to pick antibiotics over surgery when compared to choosing their own treatment.
What Factors Influence How Patients Feel About Antibiotics?
A group of 220 participants were interviewed in person to better understand decision making of potential patients. Their preferences were similar to the responses from the online survey. Those who did not choose antibiotics were then offered to change their answer based on improving conditions associated with antibiotic treatments (e.g., shorter duration of hospitalization, duration of antibiotic treatment, home nurse versus hospitalization). The responses showed how different factors could sway some participants’ decisions on whether they would undergo antibiotic treatment for appendicitis.
Newer trials are suggesting that administering antibiotics may remove the need for surgery for some patients and this study shows that the way that information is presented about antibiotics can potentially influence the choices of patients. Close to 10% of respondents in the surveys would choose antibiotics, and surgeons should explain the benefits of surgery but also should clearly offer antibiotics as an option if patients are averse to surgery.
The authors make a strong case supporting patients’ values while at the same time respecting the values of surgeons. This article serves as a reminder that patients can prefer antibiotic treatment for appendicitis even if surgeons prefer surgery, and that patient values play an important role in the treatment decision-making process.
Written by Branson Chen, BHSc
Reference: Hanson AL, Crosby RD, Basson MD. Patient Preferences for Surgery or Antibiotics for the Treatment of Acute Appendicitis. JAMA Surgery. 2018.