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A standardised measurement instrument was recommended for evaluating operator experience in complex healthcare interventions

  • A.G.K. McNair
    Correspondence
    Corresponding author: Angus G K McNair, Consultant Senior Lecturer in Colorectal Surgery, Bristol Medical School: Population Health Sciences, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK, +441173313932
    Affiliations
    National Institute for Health Research Bristol and Weston Biomedical Research Centre, Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK

    Department of Gastrointestinal Surgery, North Bristol NHS Trust, Southmead Road, Bristol, BS10 5NB, UK
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  • C. Hoffmann
    Affiliations
    National Institute for Health Research Bristol and Weston Biomedical Research Centre, Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
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  • R. Macefield
    Affiliations
    National Institute for Health Research Bristol and Weston Biomedical Research Centre, Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
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  • D. Elliott
    Affiliations
    National Institute for Health Research Bristol and Weston Biomedical Research Centre, Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
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  • J.M. Blazeby
    Affiliations
    National Institute for Health Research Bristol and Weston Biomedical Research Centre, Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
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  • Author Footnotes
    ¶ KA and SP are Joint Senior Authors
    K.L.N. Avery
    Footnotes
    ¶ KA and SP are Joint Senior Authors
    Affiliations
    National Institute for Health Research Bristol and Weston Biomedical Research Centre, Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
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  • Author Footnotes
    ¶ KA and SP are Joint Senior Authors
    S. Potter
    Footnotes
    ¶ KA and SP are Joint Senior Authors
    Affiliations
    National Institute for Health Research Bristol and Weston Biomedical Research Centre, Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK

    Bristol Breast Care Centre, North Bristol NHS Trust, Southmead Road, Bristol, BS10 5NB, UK
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  • Author Footnotes
    ¶ KA and SP are Joint Senior Authors
Open AccessPublished:October 10, 2022DOI:https://doi.org/10.1016/j.jclinepi.2022.10.006
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      Highlights

      • This study identifies, appraises, and recommends a standard measure to assess operators’ experience in studies of surgical innovation
      • Robust methodology was applied
      • Supplemental validation used semi-structured interviews with multi-national and multi-disciplinary professionals
      • The SURG-TLX is preliminarily recommended because it was found to be most relevant, comprehensive, and comprehensible
      • Routine use of a validated, standard measure to assess operators’ experience supports efficient and transparent evaluation of complex interventions involving surgical innovation

      Abstract

      Objective

      During development of complex surgical innovations, modifications occur to optimize safety and efficacy. Operators’ experiences (how professionals feel undertaking the innovation) drives this process but comprehensive overviews of measures of this concept are lacking. This study identified and appraised measures to assess operators’ experience of surgical innovation.

      Study design and setting

      There were three phases: 1) Literature reviews identified measures of operators’ experience and concepts measured were extracted and grouped into domains. 2) Quality appraisal was conducted to assess content validity of identified instruments, and was supported by COSMIN methodology. Self-reported measurement instruments that had underdone formal development were eligible. Content validity was assessed using COSMIN criteria for good content validity (rated sufficient/insufficient/indeterminate/inconsistent), informed by standards for measurement development and domains identified in phase 1. 3) Instruments determined suitable and of sufficient quality underwent supplemental appraisal in interviews with international multi-disciplinary professionals and a focus group.

      Results

      Literature reviews identified 16 measurement instruments from 243 studies. Most assessed ‘psychological’ experiences and ‘usability’. No instrument was specifically validated for innovative surgery. Three instruments were rated ‘sufficient’ (SURG-TLX) or ‘indeterminate’ (STAI,ISAT). Twenty professionals were interviewed (7 female; 15 specialties; 6 countries) and the focus group included 10 participants (4 professionals, 6 researchers). The SURG-TLX was considered the most relevant, comprehensive, and comprehensible instrument.

      Conclusion

      The SURG-TLX is preliminarily recommended to measure operators’ experiences of innovation. Further work exploring its role and impact on surgical innovation is required.

      Graphical abstract