{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T17:48:06Z","timestamp":1790531286162,"version":"4.1.0"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2020,2,20]],"date-time":"2020-02-20T00:00:00Z","timestamp":1582156800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,3,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Death after surgery is infrequent but can be devastating for the surgeon. Surgeons may experience intense emotional reactions after a patient's death, reflecting on their part in the death and the patient's loss of life. Excessive rumination or feelings of regret may have lasting negative consequences, but these reactions may also facilitate learning for future decision-making. This qualitative study analysed surgeons' reflections on what might have been done differently before a patient's death and explored non-technical (cognitive and interpersonal) aspects of care as potential targets for improvement.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>In Australia's Queensland Audit of Surgical Mortality, surgeons reflect on factors surrounding the death of patients in their care and respond to the open-ended question: in retrospect, would you have done anything differently? Framework analysis was applied to surgeons' responses to identify themes relating to non-technical aspects of care.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Responses from 1214 surgeons were analysed. Two main themes were identified. Dilemmas and difficult decisions confirmed the uncertainty, complexity and situational pressures that often precede a surgical death; regret and empathy for patients featured in some responses. In the second main theme, communication matters, surgeons cited better communication, with patients, families, colleagues and at handover, as a source of reflective change to improve decision-making and reduce regret.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Surgical decision-making involves uncertainty, and regret may occur after a patient's death. Enhancing the quality of communication with patients and peers in comprehensive assessment of the surgical patient may mitigate postdecision regret among surgeons.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1002\/bjs.11452","type":"journal-article","created":{"date-parts":[[2020,2,20]],"date-time":"2020-02-20T08:35:20Z","timestamp":1582187720000},"page":"422-431","source":"Crossref","is-referenced-by-count":23,"title":["Learning from regret"],"prefix":"10.1093","volume":"107","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1665-2137","authenticated-orcid":false,"given":"F M","family":"Boyle","sequence":"first","affiliation":[{"name":"Institute for Social Science Research, University of Queensland , Brisbane, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6576-2132","authenticated-orcid":false,"given":"J","family":"Allen","sequence":"additional","affiliation":[{"name":"Royal Australasian College of Surgeons, Queensland Audit of Surgical Mortality , Brisbane, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6875-3565","authenticated-orcid":false,"given":"T","family":"Rey-Conde","sequence":"additional","affiliation":[{"name":"Royal Australasian College of Surgeons, Queensland Audit of Surgical Mortality , Brisbane, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J B","family":"North","sequence":"additional","affiliation":[{"name":"Royal Australasian College of Surgeons, Queensland Audit of Surgical Mortality , Brisbane, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,2,20]]},"reference":[{"key":"2022100812474794100_bjs11452-bib-0001","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1111\/ans.15098","article-title":"Judgement: clinical decision-making as a core surgical competency","volume":"89","author":"Crebbin","year":"2019","journal-title":"ANZ J Surg"},{"key":"2022100812474794100_bjs11452-bib-0002","doi-asserted-by":"crossref","first-page":"1429","DOI":"10.1002\/bjs.11264","article-title":"Systematic review of the impact of patient death on surgeons","volume":"106","author":"Joliat","year":"2019","journal-title":"Br J Surg"},{"key":"2022100812474794100_bjs11452-bib-0003","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/j.suc.2011.12.002","article-title":"When bad things happen to good surgeons: reactions to adverse events","volume":"92","author":"Luu","year":"2012","journal-title":"Surg Clin North Am"},{"key":"2022100812474794100_bjs11452-bib-0004","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.1111\/medu.12058","article-title":"Waking up the next morning: surgeons' emotional reactions to adverse events","volume":"46","author":"Luu","year":"2012","journal-title":"Med Educ"},{"key":"2022100812474794100_bjs11452-bib-0005","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1016\/j.jamcollsurg.2018.01.008","article-title":"Shared decision-making in acute surgical illness: the surgeon's perspective","volume":"226","author":"Morris","year":"2018","journal-title":"J Am Coll Surg"},{"key":"2022100812474794100_bjs11452-bib-0006","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1007\/s00268-013-1948-2","article-title":"How do surgeons experience and cope with the death and dying of their patients? A qualitative study in the context of life-limiting illnesses","volume":"37","author":"Zambrano","year":"2013","journal-title":"World J Surg"},{"key":"2022100812474794100_bjs11452-bib-0007","first-page":"w20074","article-title":"Associations of regrets and coping strategies with job satisfaction and turnover intention: international prospective cohort study of novice healthcare professionals","volume":"149","author":"Cheval","year":"2019","journal-title":"Swiss Med Wkly"},{"key":"2022100812474794100_bjs11452-bib-0008","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0023138","article-title":"Regrets associated with providing healthcare: qualitative study of experiences of hospital-based physicians and nurses","volume":"6","author":"Courvoisier","year":"2011","journal-title":"PLoS One"},{"key":"2022100812474794100_bjs11452-bib-0009","doi-asserted-by":"crossref","DOI":"10.1186\/s12893-017-0240-z","article-title":"How participation in surgical mortality audit impacts surgical practice","volume":"17","author":"Lui","year":"2017","journal-title":"BMC Surg"},{"key":"2022100812474794100_bjs11452-bib-0010","doi-asserted-by":"crossref","first-page":"1276","DOI":"10.1177\/000313481207801138","article-title":"Sharing lessons learned to prevent incorrect surgery","volume":"78","author":"Neily","year":"2012","journal-title":"Am Surg"},{"key":"2022100812474794100_bjs11452-bib-0011","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1207\/s15327663jcp1701_3","article-title":"A theory of regret regulation 1.0","volume":"17","author":"Zeelenberg","year":"2007","journal-title":"J Consum Psychol"},{"key":"2022100812474794100_bjs11452-bib-0012","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1111\/j.1369-7625.2010.00621.x","article-title":"The importance and complexity of regret in the measurement of \u2018good\u2019 decisions: a systematic review and a content analysis of existing assessment instruments","volume":"14","author":"Joseph-Williams","year":"2011","journal-title":"Health Expect"},{"key":"2022100812474794100_bjs11452-bib-0013","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1177\/0272989X16636113","article-title":"Extent and predictors of decision regret about health care decisions: a systematic review","volume":"36","author":"Becerra P\u00e9rez","year":"2016","journal-title":"Med Decis Making"},{"key":"2022100812474794100_bjs11452-bib-0014","doi-asserted-by":"crossref","first-page":"1454","DOI":"10.1007\/s00268-017-3895-9","article-title":"Regret in surgical decision making: a systematic review of patient and physician perspectives","volume":"41","author":"Wilson","year":"2017","journal-title":"World J Surg"},{"key":"2022100812474794100_bjs11452-bib-0015","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1111\/ans.15233","article-title":"Being a better surgeon: a multi-competency challenge","volume":"89","author":"Watters","year":"2019","journal-title":"ANZ J Surg"},{"key":"2022100812474794100_bjs11452-bib-0016","volume-title":"Becoming a Competent and Proficient Surgeon: Training Standards for the Nine RACS Competencies","author":"Royal Australasian College of Surgeons"},{"key":"2022100812474794100_bjs11452-bib-0017","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1097\/SLA.0000000000000581","article-title":"The Australian and New Zealand audit of surgical mortality \u2013 birth, deaths, and carriage","volume":"261","author":"Raju","year":"2015","journal-title":"Ann Surg"},{"key":"2022100812474794100_bjs11452-bib-0018","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1111\/ans.14796","article-title":"Post-mortem general surgeon reflection on decision-making: a mixed-methods study of mortality audit data","volume":"88","author":"Cattanach","year":"2018","journal-title":"ANZ J Surg"},{"key":"2022100812474794100_bjs11452-bib-0019","volume-title":"The Non-Technical Skills for Surgeons (NOTSS): System Handbook v1.2","author":"University of Aberdeen; Royal College of Surgeons of Edinburgh; NHS Education for Scotland"},{"key":"2022100812474794100_bjs11452-bib-0020","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1016\/j.ejvs.2017.10.003","article-title":"Surgeons' perceptions of the causes of preventable harm in arterial surgery: a mixed-methods study","volume":"54","author":"Lear","year":"2017","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"2022100812474794100_bjs11452-bib-0021","first-page":"187","volume-title":"Analyzing Qualitative Data","author":"Ritchie","year":"2002"},{"key":"2022100812474794100_bjs11452-bib-0022","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2288-13-117","article-title":"Using the framework method for the analysis of qualitative data in multi-disciplinary health research","volume":"13","author":"Gale","year":"2013","journal-title":"BMC Med Res Methodol"},{"key":"2022100812474794100_bjs11452-bib-0023","first-page":"79","volume-title":"The SAGE Handbook of Qualitative Data Analysis","author":"Cornish","year":"2013"},{"key":"2022100812474794100_bjs11452-bib-0024","doi-asserted-by":"crossref","first-page":"2591","DOI":"10.1007\/s00268-016-3587-x","article-title":"Perioperative mortality rates in Australian public hospitals: the influence of age, gender and urgency","volume":"40","author":"Watters","year":"2016","journal-title":"World J Surg"},{"key":"2022100812474794100_bjs11452-bib-0025","volume-title":"Queensland Audit of Surgical Mortality Annual Report 2007 to 2015","year":"2016"},{"key":"2022100812474794100_bjs11452-bib-0026","doi-asserted-by":"crossref","first-page":"1721","DOI":"10.1002\/bjs.11009","article-title":"Systematic review of shared decision-making in surgery","volume":"105","author":"de Mik","year":"2018","journal-title":"Br J Surg"},{"key":"2022100812474794100_bjs11452-bib-0027","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1016\/j.amsu.2015.10.006","article-title":"The role of non-technical skills in surgery","volume":"4","author":"Agha","year":"2015","journal-title":"Ann Med Surg"},{"key":"2022100812474794100_bjs11452-bib-0028","author":"Australian Commission on Safety and Quality in Health Care","year":"2013"},{"key":"2022100812474794100_bjs11452-bib-0029","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1002\/bjs5.21","article-title":"Systematic review of psychological, emotional and behavioural impacts of surgical incidents on operating theatre staff","volume":"1","author":"Serou","year":"2017","journal-title":"BJS Open"},{"key":"2022100812474794100_bjs11452-bib-0030","first-page":"357","article-title":"Implementing shared decision making in the NHS: lessons from the MAGIC programme","volume":"j1744","author":"Joseph-Williams","year":"2017","journal-title":"BMJ"}],"container-title":["British Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fbjs.11452","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/bjs\/article-pdf\/107\/4\/422\/46377838\/bjs11452.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/bjs\/article-pdf\/107\/4\/422\/46377838\/bjs11452.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,8]],"date-time":"2022-10-08T13:16:20Z","timestamp":1665234980000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/bjs\/article\/107\/4\/422\/6120911"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,2,20]]},"references-count":30,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2020,2,20]]},"published-print":{"date-parts":[[2020,3,4]]}},"URL":"https:\/\/doi.org\/10.1002\/bjs.11452","relation":{},"ISSN":["0007-1323","1365-2168"],"issn-type":[{"value":"0007-1323","type":"print"},{"value":"1365-2168","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2020,3]]},"published":{"date-parts":[[2020,2,20]]}}}