ArticleAnnals of surgery2015
"And I think that we can fix it": mental models used in high-risk surgical decision making.
Article in Annals of surgery, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 43 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
43 citing papers in PubMed, 85 citations in OpenAlex.
- Effect of Perioperative Palliative Care on Health-Related Quality of Life Among Patients Undergoing Surgery for Cancer: A Randomized Clinical Trial.JAMA network open · 2023Trial
- A Multicenter, Randomized Controlled Trial of Perioperative Palliative Care Surrounding Cancer Surgery for Patients and Their Family Members (PERIOP-PC).Journal of palliative medicine · 2019Trial
- Trial
- Experiences and Decisional Outcomes After Cytoreductive Surgery for Peritoneal Surface Malignancy: The DECISIVE Study.Annals of surgical oncology · 2026Article
- Integrating 'what matters' conversations into preoperative care: a qualitative evaluation of surgical team workflows and barriers.BMJ quality & safety · 2026Article
- Reliability of a rating rubric to assess quality of preoperative goals of care notes.American journal of surgery · 2026Article
- Understanding Surgeon Engagement with Palliative Care Practices for Seriously Ill Patients: A Qualitative Study.Annals of surgery · 2026Article
- Review
- The Challenges of Prognosticating Persistent Critical Illness: A Qualitative Study.CHEST critical care · 2026Article
- Challenges, care gaps, and coping mechanisms in patients with advanced cancer and their caregivers following palliative gastrointestinal surgery.Palliative care and social practice · 2026Article
- Unique Challenges of Shared Decision-Making in Colorectal Surgery for the Elderly Patient.Clinics in colon and rectal surgery · 2025Article
- Clinical Momentum: An Observational Study Identifying Latent Forces Driving Surgical Interventions for Older Adults Near the End of Life.Annals of surgery · 2025Article
- A Qualitative Analysis of Physician Communication During Brain Death Conversations: Dead With a Heartbeat.Neurology. Clinical practice · 2025Article
- Decision-making Tools for Postmastectomy Breast Reconstruction: A Scoping Review.Plastic and reconstructive surgery. Global open · 2025Article
- Ensuring Goal-Aligned Care in a Busy Surgical Practice.Seminars in colon & rectal surgery · 2024Article
- Communication breakdown or clashing models?Canadian Urological Association journal = Journal de l'Association des urologues du Canada · 2024Article
- Article
- Better Conversations for Better Informed Consent: Talking with Surgical Patients.The Hastings Center report · 2024Article
- Innovations in Surgical Communication 2-Focus on the Goals of Surgery.JAMA surgery · 2023Article
- Opportunities for shared decision-making about major surgery with high-risk patients: a multi-method qualitative study.British journal of anaesthesia · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 3 institutions in 1 country.
Funding
Abstract
objectiveTo examine how surgeons use the "fix-it" model to communicate with patients before high-risk operations.
backgroundThe "fix-it" model characterizes disease as an isolated abnormality that can be restored to normal form and function through medical intervention. This mental model is familiar to patients and physicians, but it is ineffective for chronic conditions and treatments that cannot achieve normalcy. Overuse may lead to permissive decision making favoring intervention. Efforts to improve surgical decision making will need to consider how mental models function in clinical practice, including "fix-it."
methodsWe observed surgeons who routinely perform high-risk surgery during preoperative discussions with patients. We used qualitative content analysis to explore the use of "fix-it" in 48 audio-recorded conversations.
resultsSurgeons used the "fix-it" model for 2 separate purposes during preoperative conversations: (1) as an explanatory tool to facilitate patient understanding of disease and surgery, and (2) as a deliberation framework to assist in decision making. Although surgeons commonly used "fix-it" as an explanatory model, surgeons explicitly discussed limitations of the "fix-it" model as an independent rationale for operating as they deliberated about the value of surgery.
conclusionsAlthough the use of "fix-it" is familiar for explaining medical information to patients, surgeons recognize that the model can be problematic for determining the value of an operation. Whether patients can transition between understanding how their disease is fixed with surgery to a subsequent deliberation about whether they should have surgery is unclear and may have broader implications for surgical decision making.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.