Patient choice in management of acute appendicitis

imageIn an article in JAMA Surgery this week, the authors show not only that it is safe (and perhaps safer) to treat uncomplicated appendicitis nonoperatively but also that letting parents choose  the treatment option for their child is an effective strategy. The question of safety has been addressed in prior adult and pediatric trials, leading to growing consensus that in a specific subset of patients with uncomplicated acute appendicitis it is safe to treat nonoperatively. Further, they found that patients whose parents selected nonoperative management incurred  less morbidity (days of normal activity missed by the patient or parent) and lower costs than those whose parents chose surgery.

This study is important not only because it reproduces prior findings of the safety of nonoperative management in certain patients, but even more so because it highlights the concept of patient choice–driven treatment. As I mentioned in a post earlier this week, this concept has been shown to both empower the patient and improve overall patient satisfaction.

The invited commentary accompanying the article paints shared decision making in black and white extremes: “Further study is needed in this arena before we completely abdicate the responsibility for guiding our patient’s decision making. Many patients still want us to be “doctors,” not Google impersonators.” As a patient or provider, does patient choice feel like providers are completely abdicating their responsibility for guiding decision-making?


Published by Marion Sills

I am a Professor of Pediatrics and Emergency Medicine at the University of Colorado. I work as a physician in the emergency departments of the Children's Hospital of Colorado and as a health services researcher at the University's Adult and Child Consortium for Health Outcomes (ACCORDS).

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