The Patient Perspective on Colectomy for Recurrent Diverticulitis

Abstract

Objective: Understand the patient decision-making process regarding colectomy for recurrent diverticulitis. Summary Background Data: The decision to pursue elective colectomy for recurrent diverticulitis is highly preference sensitive. Little is known about the patient perspective in this decision-making process. Methods: We performed a qualitative study utilizing focus groups of patients with recurrent diverticulitis at three centers across the United States. Using an iterative inductive/deductive approach, we developed a conceptual framework to capture the major themes identified in the coded data. Results: From March 2019-July 2020, 39 patients were enrolled across three sites and participated in six focus groups. After coding the transcripts using a hierarchical coding system, a conceptual framework was developed. Major themes identified included: participants’ beliefs about surgery, such as normative beliefs (e.g., subjective, value placed on surgery), control beliefs (e.g., self-efficacy, stage of change) and anticipated outcomes (e.g., expectations, anticipated regret); the role of behavioral management strategies (e.g., fiber, eliminate bad habits); emotional experiences (e.g., depression, embarrassment); current symptoms (e.g., severity, timing); and quality of life (e.g., cognitive load, psychosocial factors). Three sets of moderating factors influencing patient choice were identified: clinical history (e.g., source of diagnosis, multiple surgeries), clinical protocols (e.g., pre- and post-op education) and provider-specific factors (e.g., specialty, choice of surgeon). Conclusions: Patients view the decision to undergo colectomy through three major themes- their beliefs about surgery, their psychosocial context and moderating factors that influence participant choice to undergo surgery. This knowledge is essential both for clinicians counseling patients who are considering colectomy and for researchers studying the process to optimize care for recurrent diverticulitis.