1 Department of Surgery, Duke University Medical Center, Durham, North Carolina2 Center for Advanced Hindsight, Duke University, Durham, North Carolina
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BACKGROUND:Surgeons present patients with complex information at the perioperative appointment. Emotions likely play a role in surgical decision-making, and disgust is an emotion of revulsion at a stimulus that can lead to avoidance.OBJECTIVE:The purpose of this study was to determine the impact of disgust on intention to undergo surgical resection for colorectal cancer and recall of perioperative instructions.DESIGN:This was a cross-sectional observational study conducted online using hypothetical scenarios with nonpatient subjects.SETTINGS:The study was conducted using Amazon’s Mechanical Turk.PATIENTS:Survey respondents were living in the United States.MAIN OUTCOME MEASURES:Surgery intention and recall of perioperative instructions were measured.RESULTS:A total of 319 participants met the inclusion criteria. Participants in the experimental condition, who were provided with detailed information and pictures about stoma care, had significantly lower surgery intentions (mean ± SD, 4.60 ± 1.15) compared with the control condition with no stoma prompt (mean ± SD, 5.14 ± 0.91; p = 0.05) and significantly lower recall for preoperative instructions (mean ± SD, 13.75 ± 2.38) compared with the control condition (mean ± SD, 14.36 ± 2.19; p = 0.03). Those within the experimental conditions also reported significantly higher state levels of disgust (mean ± SD, 4.08 ± 1.74) compared with a control condition (mean ± SD, 2.35 ± 1.38; p < 0.001). State-level disgust was found to fully mediate the relationship between condition and recall (b = –0.31) and to partially mediate the effect of condition on surgery intentions (b = 0.17).LIMITATIONS:It is unknown whether these results will replicate with patients and the impact of competing emotions in clinical settings.CONCLUSIONS:Intentions to undergo colorectal surgery and recall of preoperative instructions are diminished in patients who experience disgust when presented with stoma information. Surgeons and care teams must account for this as they perform perioperative counseling to minimize interference with recall of important perioperative information. See Video Abstract at http://links.lww.com/DCR/A776.