Clinicians’ views and attitudes towards perioperative or surgical risk prediction calculators: A systematic thematic synthesis

Background Surgical-and-Perioperative Risk Prediction Calculators (SPRPCs) help predict patients’ safety outcomes for proposed surgical procedures. These evidence-based assessments can inform shared decision-making between patients and providers – improving patient safety, satisfaction and care. However, evidence persistently indicates low use of SPRPCs in surgical care. We reviewed qualitative literature to explore surgeons’ and anaesthetists’ attitudes and perceptions of features of SPRPCs, facilitators, barriers and complexity influencing their adoption. Method A systematic literature search was performed across three bibliographic databases. A two-stage screening process was performed using pre-determined inclusion and exclusion criteria. The Joanna Biggs Institute (JBI) checklist was used to critically assess quality. Qualitative data from included studies were analysed using thematic synthesis. Results Four qualitative and two mixed-methods paper were included, reporting data from 72 clinicians in total. Three studies focused on orthopaedic surgery SPRPCs, two on the Surgical Perioperative Assessment System tool and one on post-anaesthetic care unit hypotension prediction. Six facilitator, and four barrier, themes were identified. SPRPCs were seen as valuable in lowering patients’ risk of harm and supporting: informed consent discussions, declining surgery, and staff communication. These benefits were contingent on SPRPCs being transparent, accurate and integrated with care pathways. Conversely, some argued SPRPCs do not change clinical decisions, pose a threat to autonomy and patient-centred care and open the clinician to legal liability. Conclusions SPRPCs are underutilised when developed without consideration of clinicians’ needs and workflow. Findings highlight the importance of clinicians’ involvement in SPRPC design. Further research would support improvements in their clinical adoption.