title: A comparison of patient and physician beliefs about infrainguinal bypass operation: what role should surgical optimism play?
abstract: BACKGROUND
  Risk and outcomes of infrainguinal bypass operation vary by identifiable patient characteristics. Previously, we found that although patients appear willing to undertake considerable risk, they may have unrealistic expectations for operative benefits. Little is known about whether patients and physicians have similar beliefs regarding the risks and benefits of the operation.
  
  
  METHODS
  Cross-sectional paired surveys of 6 surgeons and 45 of their patients undergoing infrainguinal bypass operation at a large university medical center.
  
  
  RESULTS
  Similar proportions of physicians and patients reported risks associated with the operation. There was moderate agreement within patient-surgeon pairs regarding specific risks such as the likely need for additional operations or for amputation despite the procedure (agreement ranging from 60% to 69% of patient-physician pairs). In nearly two thirds (62%) of cases surgeons provided more optimistic prognostic estimates of 5-year mortality than is suggested by prior research (McNemar test, P < .001). In turn, patients tended to be more optimistic regarding their estimated 5-year survival than their surgeons, with 56% of patients estimating a lesser 5-year mortality than that predicted by their surgeon (McNemar test, P < .01).
  
  
  CONCLUSIONS
  Although surgeons and patients generally agree regarding the risks of infrainguinal bypass operation, both groups appear more optimistic regarding likely 5-year survival than the outcomes suggested by prior research. This optimism may play an important role in the decision to proceed with infraninguinal bypass operation, as well as the preservation of hope regarding the potential long-term benefits of such intervention.
authors.affiliation: Department of Surgery, MacLean Center for Clinical Medical Ethics, University of Chicago, IL, USA. schwarze@surgery.wisc.edu
authors.forename: Margaret L
authors.initials: ML
authors.lastname: Schwarze
authors.forename: Maliha A
authors.initials: MA
authors.lastname: Sayla
authors.forename: G Caleb
authors.initials: GC
authors.lastname: Alexander
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D013502:General Surgery; D007722:Health Knowledge, Attitudes, Practice; D006304:Health Status; D006801:Humans; D023821:Limb Salvage / Q000379:methods* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D010358:Patient Participation / Q000523:psychology*; D011379:Prognosis; D018570:Risk Assessment