Decision-making in the management of recurrent tonsillitis
Research type
Research Study
Full title
Decision-making in adults referred to ENT for management of recurrent tonsillitis
IRAS ID
171617
Contact name
Nishchay Mehta
Contact email
Sponsor organisation
UCL-UCLH Joint Research Office
Duration of Study in the UK
1 years, 0 months, 0 days
Research summary
Background
There is wide geographical variation in the rates of many surgical procedures. Even after accounting for factors such as age sex, social deprivation and disease burden considerable variation persists. Most studies have shown that variation in surgical rates is greatest in procedures for which the efficacy is unproven and a source of professional uncertainty. Although professional uncertainty seems to be associated with higher rates of variation the role of uncertainty in explaining variation has not yet been explored. Using the example of tonsillectomy for adults with recurrent tonsillitis, we will study the role of clinician and patient decisional uncertainty on regional surgical rate variation. We will use a validated instrument (the Decisional Conflict Scale questionnaires; DCS) to measure uncertainty, for both patients and clinicians. We will evaluate the impact of decisional uncertainty on the treatment choices and satisfaction, whilst controlling for factors that are known to be associated with healthcare variations (such as age, sex, disease factors, socio-economic status and patients’ preferences for treatments).
Aim
The aim of this study is to investigate the role of decisional uncertainty on whether adults with recurrent tonsillitis chose tonsillectomy or watchful waiting to treat their condition following specialist consultation.
Method
We will ask 150 adults with recurrent tonsillitis and their consulting ENT surgeons from 8 ENT clinics in England to join our study. We will measure decisional uncertainty, satisfaction and preferences guiding the treatment decision. Analysis will include 1) the role of patient and surgeon decisional uncertainty on decisional outcome 2) the association between patient and surgeon decisional uncertainty; 3) the role of patient factors (including patients’ preferences) on decisional uncertainty (patient and clinician) and decisional outcome.
Outputs
The results will help understand what role the process of medical decision-making plays in geographical variation in tonsillectomy rates.REC name
East Midlands - Nottingham 1 Research Ethics Committee
REC reference
15/EM/0191
Date of REC Opinion
8 May 2015
REC opinion
Further Information Favourable Opinion