Background
No study has specifically investigated patient attitudes on decisional regret concerning
major operative procedures. The objective of the present study was to define the prevalence
of regret among patients who had undergone a major abdominal or thoracic operative
procedure and to identify factors associated with postoperative regret.
Methods
Decisional regret was assessed using the validated Decision Regret Scale, which consisted
of 5 items with Likert-scale responses. Data on preoperative decision-making preferences
and postoperative regret, quality of life, and symptoms of anxiety and depression
were collected and analyzed.
Results
Overall, 157 (68.9%) patients agreed to participate and completed the survey, while
12 (5.3%) patients declined citing lack of time or interest. The types of operative
procedures varied, with 65 (41.7%) patients undergoing a thoracic operation, 59 (37.8%)
resection of the pancreas, liver or bile duct, and 32 (20.5%) patients having a colorectal/enteric
operation. Although most patients (n = 98, 62.4%) expressed no degree of regret, a subset of patients did; specifically,
59 (37.6%) patients conveyed a varied degree of postoperative regret, with 20 (12.7%)
patients expressing a moderate degree of regret, and 13 patients (8.3%) experiencing
substantial regret. Postoperative regret was associated with a history of postoperative
complications (odds ratio 4.7, 95% confidence interval 1.2–17.7, P < .01) and with discordance between a patient's preferred and actual perceived decision-making
role (odds ratio 5.3, 95% confidence interval 1.6–17.4, P < .01). Patients experiencing regret were 5 times more likely than patients not experiencing
regret to demonstrate borderline or abnormal depression scores (odds ratio 5.4, 95%
confidence interval 1.6–18.0, P < .01); anxiety scores directly correlated with regret (rho 0.254, P < .01).
Conclusion
Patient-reported decisional regret after major abdominal and thoracic operations was
present in 37% of patients, with roughly 1 in 12 patients reporting substantial regret
and distress over the decision to have undergone operation. Discordance between patients'
preferred and actual involvement in operative decision-making was associated with
postoperative regret, as was poor quality of life, anxiety, and depression.
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Article info
Publication history
Published online: December 16, 2016
Accepted:
October 24,
2016
Footnotes
This publication was made possible by the Johns Hopkins Institute for Clinical and Translational Research that is funded in part by Grant Number UL1 TR 001079 from the National Center for Advancing Translational Sciences, a component of the National Institutes of Health (NIH), and the NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the Johns Hopkins Institute for Clinical and Translational Research, National Center for Advancing Translational Sciences, or NIH.
The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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© 2016 Elsevier Inc. All rights reserved.
