Why do thoracic surgeons need training in decision making? Many of us who have weathered harrowing residencies in surgery feel that, after such experiences, decision making is a natural extension of our selves. While this is no doubt true, correct de- sion making is something that many of us have yet to master. The impetus to develop a text on evidence-based decision making in thoracic surgery was stimulated by a conference for cardiothoracic surgical trainees developed in 2004 and sponsored by the American College of Chest Physicians. During that conference it became clear that we as thoracic surgeons are operating from a very limited fund of true evidence-based information. What was also clear was the fact that many of the decisions we make in our everyday practices are not only uninformed by evidence-based medicine, but often are contradictory to existing guidelines or evidence-based recommendations. The objectives of this book are to explain the process of decision making, both on the part of the physician and on the part of the patient, and to discuss speci? c clinical problems in thoracic surgery and provide recommendations regarding their mana- ment using evidence-based methodology. Producing a text that will purportedly guide experienced, practicing surgeons in the decision-making process that they are acc- tomed to observe on a daily basis is a daunting task.
Difficult Decisions in Thoracic Surgery: An Evidence-Based Approach describes the recommended ideal approach, rather than customary care, in selected clinical situations.
Brief chapters are devoted to a specific question or decision in general thoracic surgery that is difficult or controversial. Although some of the content may be available in major thoracic texts, rarely are such questions posed specifically and analyzed according to the level of supporting evidence available. This book is unique in aiming to address the issues in the most clear and informed manner possible; the chapters contain both evidence-based recommendations and descriptions of surgeons' personal practices based on their experience and the published literature.
Chapters are organized around clearly identified recommendations. This provides uniformity to the presentations, making possible the identification of useful material at a glance. A general introduction describes evidence-based data and their use, decision analytic models, and how both physicians and patients make decisions currently. Over 50 different topics are then presented, including a review of available evidence and a general discussion of recommended practice.
This book is a valuable reference source for practicing surgeons, surgeons in training, and educators.
