| Abstract: | ABSTRACT: BACKGROUND: Routine pre-operative tests for anesthesia management are often ordered by bothanesthesiologists and surgeons for healthy patients undergoing low-risk surgery. TheTheoretical Domains Framework (TDF) was developed to investigate determinants ofbehaviour and identify potential behaviour change interventions. In this study, the TDF is used to explore anaesthesiologists' and surgeons' perceptions of ordering routine tests forhealthy patients undergoing low-risk surgery. METHODS: Sixteen clinicians (eleven anesthesiologists and five surgeons) throughout Ontario wererecruited. An interview guide based on the TDF was developed to identify beliefs about preoperativetesting practices. Content analysis of physicians' statements into the relevanttheoretical domains was performed. Specific beliefs were identified by grouping similarutterances of the interview participants. Relevant domains were identified by noting thefrequencies of the beliefs reported, presence of conflicting beliefs, and perceived influence onthe performance of the behaviour under investigation. RESULTS: Seven of the twelve domains were identified as likely relevant to changing clinicians'behaviour about pre-operative test ordering for anesthesia management. Key beliefs wereidentified within these domains including: conflicting comments about who was responsiblefor the test-ordering (Social/professional role and identity); inability to cancel tests orderedby fellow physicians (Beliefs about capabilities and social influences); and the problem withtests being completed before the anesthesiologists see the patient (Beliefs about capabilitiesand Environmental context and resources). Often, tests were ordered by an anesthesiologistbased on who may be the attending anesthesiologist on the day of surgery while surgeonsordered tests they thought anesthesiologists may need (Social influences). There were alsoconflicting comments about the potential consequences associated with reducing testing,from negative (delay or cancel patients' surgeries), to indifference (little or no change inpatient outcomes), to positive (save money, avoid unnecessary investigations) (Beliefs aboutconsequences). Further, while most agreed that they are motivated to reduce orderingunnecessary tests (Motivation and goals), there was still a report of a gap between theirmotivation and practice (Behavioural regulation). CONCLUSION: We identified key factors that anesthesiologists and surgeons believe influence whether theyorder pre-operative tests routinely for anesthesia management for a healthy adults undergoinglow-risk surgery. These beliefs identify potential individual, team, and organisation targetsfor behaviour change interventions to reduce unnecessary routine test ordering. |
