title: To operate or not--the impact of a lecture on radical glioblastoma surgery and different treatment options on decision-making for oneself and patients.
abstract: BACKGROUND
  Clinical decision-making involves a complex interaction between patients and caregivers. The medical knowledge and values of caregivers are essential for treatment recommendations. This study was undertaken to evaluate treatment recommendations by a group of Scandinavian neurosurgeons before and after an expert lecture on glioblastoma surgery.
  
  
  METHODS
  An interactive voting system was used to record responses to four questions regarding glioblastoma management before and after a 25-min lecture on the benefit of radical glioblastoma surgery.
  
  
  RESULTS
  The majority of the audience aimed at radical surgery combined with radiotherapy before (76%) and after (88%) the lecture. The proportion who recommended immediate postoperative follow-up by MRI increased from 34% to 75%. Fourteen percent (before) and 45% (after) recommended renewed surgery to remove small residuals in patients, while 52% (before) and 60% (after) would have wanted to be re-operated if they themselves had been patients.
  
  
  CONCLUSIONS
  The views on optimum management differed widely in a relatively homogeneous group of neurosurgeons. The lecture had a major impact on decision-making. A large proportion of the attendees recommended different management strategies for themselves and for their patients. The findings indicated the need to analyze the evaluation of medical knowledge, discuss the ethics of decision-making and encourage second opinions for serious neurosurgical decisions.
authors.affiliation: Department of Neurosurgery, Karolinska Hospital, 171 76 Stockholm, Sweden. tiit.mathiesen@karolinska.se
authors.forename: Tiit
authors.initials: T
authors.lastname: Mathiesen
mesh_terms: D001932:Brain Neoplasms / Q000175:diagnosis / Q000601:surgery*; D003657:Decision Making; D005909:Glioblastoma / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D019635:Neurosurgical Procedures; D010820:Physicians / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires