Parastomal hernia; Prosthetic mesh; Shared decision makingHèrnia parastomal; Malla protèsica; Presa de decisions compartidaHernia paraestomal; Malla protésica; Toma de decisiones compartid

García-Alamino, J. M.

LOPEZ-CANO, MANUEL

English

Scientia, Dipòsit d’Informació Digital del Departament de Salut

The Importance of Shared DecisionMaking in the Decision to Prevent aParastomal Hernia With ProstheticMeshM. López-Cano1* and J. M. García-Alamino21Abdominal Wall Surgery Unit, Department of General Surgery, Hospital Universitari Vall d’Hebron, Universitat Autònoma deBarcelona, Barcelona, Spain, 2Global Health, Gender and Society (GHenderS), Facultat de Ciències de la Salut, Blanquerna-Universitat Ramón Llull, Barcelona, SpainKeywords: decision making, hernia, parastomal hernia, prosthetic mesh, shared decision making (SDM), preventionIn the modern context of surgery, where respect for patient autonomy is paramount, thedecision-making process should not be unilateral [1]. In this environment, the Shared DecisionMaking (SDM) model emerges as an essential tool [2]. This model can be used as a “tool” thatallows surgeons to “work” together with their patients in making decisions regardingdiagnostic tests, treatments, and/or care plans that involve various interventions [1].Furthermore, the improved bidirectional communication between surgeon and patient thatthe practice of SDM entails can limit the use of an intervention that is unlikely to benefit thepatient, does not align with their desires, or both [3]. Different ways of carrying out the steps ofthe SDM process have been described, but essentially, they all describe similar concepts. For itssimplicity and clarity, the SHARE Approach developed by the Agency for Healthcare Researchand Quality (AHRQ) in the United States can serve as a guide for surgeons less familiar withSDM [4].Clinical practice guidelines (CPGs) have been defined as “statements that includerecommendations intended to optimize patient care that are informed by a systematic review ofthe evidence and an assessment of the benefits and harms of alternative care options” [5]. Probably,the best current methodology for developing a CPG is the GRADE (Grading of RecommendationsAssessment, Development and Evaluation) methodology [6]. However, on many occasions, therecommendations in guidelines are rated as weak in the GRADE system [7–11], indicating thepresence of different options or approaches, a delicate balance between risks and benefits, oruncertainty in the evidence. In these circumstances of variability and uncertainty in therecommendation, each patient may make different decisions based on their individual valuesand preferences, and the “application” of the recommendation should not be a unilateraldecision by the surgeon [1]. Therefore, SDM is essential for implementing weakrecommendations that are consistent with patients’ values and preferences, both for therapeuticand preventive options [12].In 2018 guidelines for the prevention and treatment of parastomal hernia (PH) coming from theEuropean Hernia Society (EHS) were published [8]. A recent update of these guidelines (followingthe GRADE methodology) on the specific topic of using a prosthetic mesh in the prevention of PHhas been published [13] and makes a strong recommendation for the use of mesh in cases of patientsat high risk of PH after end colostomy construction (patients with a history of abdominal wall hernia,connective tissue disorder, obesity, or undergoing chemotherapy) and a life expectancy of over2 years. However, when it comes to generalizing to other types of patients (no high risk), theyconditionally (weak) suggest/recommend the use of a non-absorbable synthetic prophylactic mesh inend colostomy construction [13].*Correspondence:M. López-Cano27689mlc@comb.catReceived: 27 October 2023Accepted: 03 November 2023Published: 10 November 2023Citation:López-Cano M andGarcía-Alamino JM (2023) TheImportance of Shared Decision Makingin the Decision to Prevent a ParastomalHernia With Prosthetic Mesh.J. Abdom. Wall Surg. 2:12316.doi: 10.3389/jaws.2023.12316Journal of Abdominal Wall Surgery | Published by Frontiers November 2023 | Volume 2 | Article 123161EDITORIALpublished: 10 November 2023doi: 10.3389/jaws.2023.12316In the context described above, the use of SDM appearsindispensable for a significant majority of patients whendeciding whether to implant a mesh to reduce the risk ofPH. Some of the reasons why SDM is crucial in this decisioninclude:Individual values and preferences: Each patient has uniquevalues, goals, and expectations. Considering their ownexperience and unique situation, patients can make better-informed decisions when they understand the informationprovided and how it relates to their current clinical contextand possible future outcomes. Some may prioritize preventing ahernia, given its potential impact on quality of life, while othersmay be more cautious about introducing synthetic materialsinto their bodies.Clinical outcomes and quality of life: Medical decisions notonly affect objective clinical outcomes but also the patient’sperception of their quality of life. Shared decision-makingallows for a more comprehensive assessment of how anintervention might affect daily life, emotional wellbeing, andphysical activities. This is particularly relevant when there is alack of reported patient evidence on their health outcomes (e.g.,patient-reported outcomes).Promoting patient autonomy: SDM strengthens patientautonomy by making them active participants in the decision-making process. This not only aligns with ethical principles inmedicine but can also increase patient satisfaction and adherenceto postoperative recommendations.Education and understanding: This model promotes abidirectional exchange of information. While the physicianprovides evidence-based information, the patient contributestheir personal knowledge and unique context. This ensuresthat the patient has a comprehensive understanding of theintervention and its potential implications.Reducing post-decision regrets: Making medical decisions canbe stressful, and decisions made without sufficient deliberation orunderstanding can lead to regrets. SDM reduces the likelihoodthat patients will feel dissatisfied or uncertain about their long-term decisions.In conclusion, the decision to reduce the risk of a PH withprosthetic mesh should not be taken lightly. It is a choicethat has significant implications for health outcomes andquality of life, with recent literature questioning theeffectiveness of non-absorbable synthetic mesh in preventingPH in the context of an end colostomy when long-term follow-up is considered [14]. The SDM model emerges as aninvaluable tool to ensure that an informed, balanceddecision is made, aligned with the individual values anddesires of the patient.AUTHOR CONTRIBUTIONSML-C and JG-A contributed equally to the conception, draftingand review of this manuscript. All authors contributed to thearticle and approved the submitted version.CONFLICT OF INTERESTThe authors declare that the research was conducted in theabsence of any commercial or financial relationships thatcould be construed as a potential conflict of interest.PUBLISHER’S NOTEAll claims expressed in this article are solely those of the authorsand do not necessarily represent those of their affiliatedorganizations, or those of the publisher, the editors, and thereviewers. Any product that may be evaluated in this article, orclaim that may be made by its manufacturer, is not guaranteed orendorsed by the publisher.REFERENCES1. Hawkins AT, Fayanju OM, Maduekwe UN. Shared Decision-Making inthe Surgical Sciences. JAMA Surg (2023). doi:10.1001/jamasurg.2023.23962. Elwyn G, Frosch D, Thomson R, Joseph-Williams N, Lloyd A, Kinnersley P,et al. Shared Decision Making: A Model for Clinical Practice. J Gen Intern Med(2012) 27(10):1361–7. doi:10.1007/s11606-012-2077-63. Clapp JT, Schwarze ML, Fleisher LA. Surgical Overtreatment and SharedDecision-Making-The Limits of Choice. JAMA Surg (2022) 157(1):5–6. doi:10.1001/jamasurg.2021.44254. Agency for Healthcare Research and Quality. The SHARE Approach—EssentialSteps of Shared Decisionmaking: Expanded Reference Guide With SampleConversation Starters (2023). Available From: https://www.ahrq.gov/health-literacy/professional-training/shared-decision/tool/resource-2.html (AccessedOctober 12, 2023).5. FieldMJ, Lohr KN, editors.Clinical Practice Guidelines: Directions for a NewAgency.Institute of Medicine. Washington D.C.: National Academic Press (1990). p. 58.6. López-CanoM, García Alamino J. Guidelines: Options and Limit In: The Art ofHernia Surgery. Berlin, Germany: Springer (2018). p. 79–88. ISBN: 978-3-319-72624-3.7. López-Cano M, García-Alamino JM, Antoniou SA, Bennet D, Dietz UA,Ferreira F, et al. EHS Clinical Guidelines on the Management of theAbdominal Wall in the Context of the Open or Burst Abdomen. Hernia(2018) 22(6):921–39. doi:10.1007/s10029-018-1818-98. Antoniou SA, Agresta F, Garcia Alamino JM, Berger D, Berrevoet F, BrandsmaHT, et al. European Hernia Society Guidelines on Prevention and Treatment ofParastomal Hernias. Hernia (2018) 22(1):183–98. doi:10.1007/s10029-017-1697-59. HerniaSurge Group. International Guidelines for Groin Hernia Management.Hernia (2018) 22(1):1–165. doi:10.1007/s10029-017-1668-x10. Deerenberg EB, Henriksen NA, Antoniou GA, Antoniou SA, Bramer WM,Fischer JP, et al. Updated Guideline for Closure of Abdominal Wall IncisionsFrom the European and American Hernia Societies. Br J Surg (2022) 109(12):1239–50. doi:10.1093/bjs/znac30211. Hernández-Granados P, Henriksen NA, Berrevoet F, Cuccurullo D, López-Cano M, Nienhuijs S, et al. European Hernia Society Guidelines onJournal of Abdominal Wall Surgery | Published by Frontiers November 2023 | Volume 2 | Article 123162López-Cano and García-Alamino The Importance of Shared Decision MakingManagement of Rectus Diastasis. Br J Surg (2021) 108(10):1189–91. doi:10.1093/bjs/znab12812. Grad R, Légaré F, Bell NR, Dickinson JA, Singh H, Moore AE, et al. SharedDecision Making in Preventive Health Care: What It Is; What It Is Not. CanFam Physician (2017) 63(9):682–4. PMID: 28904031; PMCID:PMC5597010.13. Stabilini C, Muysoms F, Tzanis AA, Rossi L, Koutsiouroumpa O, MavridisD, et al. EHS Rapid Guideline: Evidence-Informed EuropeanRecommendations on Parastomal Hernia Prevention—With ESCP andEAES Participation. J Abdom Wall Surg (2023) 2. doi:10.3389/jaws.2023.1154914. Verdaguer M, García-Alamino JM, Rodrigues-Gonçalves V, Martinez-Lopez MP,López-Cano M. Prophylactic Mesh Does Not Prevent Parastomal Hernia atLongterm: Meta-Analysis and Trial Sequential Analysis. Surgery (2023). In press.Copyright © 2023 López-Cano and García-Alamino. This is an open-access articledistributed under the terms of the Creative Commons Attribution License (CC BY).The use, distribution or reproduction in other forums is permitted, provided theoriginal author(s) and the copyright owner(s) are credited and that the originalpublication in this journal is cited, in accordance with accepted academic practice.No use, distribution or reproduction is permitted which does not comply with theseterms.Journal of Abdominal Wall Surgery | Published by Frontiers November 2023 | Volume 2 | Article 123163López-Cano and García-Alamino The Importance of Shared Decision Making

The Importance of Shared Decision Making in the Decision to Prevent a Parastomal Hernia With Prosthetic Mesh

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The Importance of Shared Decision Making in the Decision to Prevent a Parastomal Hernia With Prosthetic Mesh

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