Nonclinical components of surgical decision making

Abstract

Examining surgical trends before the National Emphysema Treatment Trial (NETT) demonstrates the importance of nonclinical determinants of care. The number of lung volume reduction surgery (LVRS) claims increased dramatically after 1994 despite the fact that there was considerable uncertainty in the available evidence base. Favorable media reports and testimonials from patient advocacy groups may have influenced both patient and surgeon attitudes about LVRS. Some surgeons felt that investigations prior to the NETT demonstrated clear and dramatic improvements in quality of life, sufficient to justify Medicare reimbursement for the procedure. Accordingly, they believed the NETT was a form of coercion because patients who refused to enroll in the study would not have financial coverage of their LVRS or receive the operation from a NETT surgeon. Furthermore, even if patients enrolled, the study deprived half of them a procedure with established benefits. © 2007 Springer-Verlag London Limited.