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Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests
Open accessAbstract
BACKGROUND: Routine pre-operative tests for anesthesia management are often ordered by both anesthesiologists and surgeons for healthy patients undergoing low-risk surgery. The Theoretical Domains Framework (TDF) was developed to investigate determinants of behaviour and identify potential behaviour change interventions. In this study, the TDF is used to explore anaesthesiologists' and surgeons' perceptions of ordering routine tests for healthy patients undergoing low-risk surgery. METHODS: Sixteen clinicians (eleven anesthesiologists and five surgeons) throughout Ontario were recruited. An interview guide based on the TDF was developed to identify beliefs about pre-operative testing practices. Content analysis of physicians' statements into the relevant theoretical domains was performed. Specific beliefs were identified by grouping similar utterances of the interview participants. Relevant domains were identified by noting the frequencies of the beliefs reported, presence of conflicting beliefs, and perceived influence on the performance of the behaviour under investigation. RESULTS: Seven of the twelve domains were identified as likely relevant to changing clinicians' behaviour about pre-operative test ordering for anesthesia management. Key beliefs were identified within these domains including: conflicting comments about who was responsible for the test-ordering (Social/professional role and identity); inability to cancel tests ordered by fellow physicians (Beliefs about capabilities and social influences); and the problem with tests being completed before the anesthesiologists see the patient (Beliefs about capabilities and Environmental context and resources). Often, tests were ordered by an anesthesiologist based on who may be the attending anesthesiologist on the day of surgery while surgeons ordered tests they thought anesthesiologists may need (Social influences). There were also conflicting comments about the potential consequences associated with reducing testing, from negative (delay or cancel patients' surgeries), to indifference (little or no change in patient outcomes), to positive (save money, avoid unnecessary investigations) (Beliefs about consequences). Further, while most agreed that they are motivated to reduce ordering unnecessary tests (Motivation and goals), there was still a report of a gap between their motivation and practice (Behavioural regulation). CONCLUSION: We identified key factors that anesthesiologists and surgeons believe influence whether they order pre-operative tests routinely for anesthesia management for a healthy adults undergoing low-risk surgery. These beliefs identify potential individual, team, and organisation targets for behaviour change interventions to reduce unnecessary routine test ordering.
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Written from the paper’s full text.
TL;DR
This interview study applied the Theoretical Domains Framework to explore why anesthesiologists and surgeons order routine pre-operative tests for healthy patients undergoing low-risk surgery. It identified seven potentially relevant domains, especially social/professional role and identity, beliefs about capabilities and consequences, environmental context and resources, and social influences, as targets for reducing unnecessary testing.
Key findings
- Seven of the 12 TDF domains were judged likely relevant to changing pre-operative test-ordering behaviour: Social/professional role and identity, Beliefs about capabilities, Beliefs about consequences, Environmental context and resources, Social influences, Behavioural regulation, and Nature of the behaviour. Five domains were reported as less relevant: Knowledge, Motivation and goals, Skills, Memory/attention/decision processes, and Emotion.
- Among 16 participants (11 anesthesiologists, 5 surgeons), 459 utterances were coded into the 12 domains, with almost perfect interrater agreement (κ = 0.84; 95% CI 0.807–0.878). Beliefs included that ordering tests was very easy (16/16), confidence in assessing a low-risk patient without pre-op tests (11/16), that reducing routine tests would save money (11/16), little or no change in outcomes (10/16), and possible delay or cancellation of surgery (9/16).
- Clinicians reported conflicting views about who was responsible for ordering tests. Anesthesiologists described difficulty or reluctance cancelling tests ordered by surgeons and noted tests were often completed before they saw the patient; they sometimes ordered tests they felt unnecessary because a more conservative colleague might be the attending anesthesiologist. Surgeons reported ordering tests they thought anesthesiologists might need.
- Most agreed they were motivated to reduce unnecessary tests, but a gap between motivation and practice was reported. Suggested changes included policy taking test ordering out of surgeons’ hands and better evidence that testing is unnecessary in low-risk patients.
Methods
- Semi-structured interview study using an interview topic guide based on the Theoretical Domains Framework. The behaviour of interest was ordering pre-operative chest x-ray and electrocardiograph for anesthesia management in healthy patients having low-risk surgery (e.g., knee arthroscopy, laparoscopic cholecystectomy, cataract removal/lens replacement, and similar surgeries).
- Sixteen clinicians in Ontario were recruited: 11 anesthesiologists (9 male; 2 female) and 5 surgeons (all male), from community (n = 3) and academic hospitals (n = 5) in six health regions. Recruitment used snowball sampling supplemented with purposive sampling; interviews lasted 14–46 minutes; data saturation occurred after 16 interviews.
- Two researchers coded 459 utterances into the 12 TDF domains, calculated Fleiss’s kappa, and resolved disagreements by consensus. Specific beliefs were grouped, and relevant domains were identified by frequency of beliefs, presence of conflicting beliefs, and perceived influence on the behaviour.
Limitations
- The paper states that saturation could have been reached prematurely if participants recommended others with similar opinions; that identified themes are clinicians’ views about what might influence practice, not evidence of actual influences; and that the interview guide mixed descriptive and diagnostic questions, requiring interpretation by the research team.
- Evident from the text: the sample was small (16 clinicians), all surgeons and most anesthesiologists were male, recruitment was from a single Canadian province, surgeons were not purposively sampled by subspecialty, and the data are self-reported interview accounts, limiting generalizability.
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73 Own result · 22 Not checked yet · 11 Own interpretation · 10 Own method · 2 No basis given · 1 Supported so far
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“and the problem with tests being completed before the anesthesiologists see the patient (Beliefs about capabilities and Environmental context and resources).”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Abstract > Results
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“all respondents interviewed stated that their own emotions would not influence whether they ordered pre-operative tests or not”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Results > Domains reported not relevant
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“some stated that routinely ordering tests was not an important part of their pre-operative evaluation”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Results > Domains reported not relevant
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Further, the existence of hospital directives varied from hospital to hospital throughout the province”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Discussion
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Second, evidence of the inter-professional influences among the attending surgeon performing the surgery, the anesthesiologist at pre-admission ordering the tests, and attending anesthesiologist providing intraoperative care was reported by the vast majority of respondents”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Discussion
plaincorrelational- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Both groups reported that they didn’t feel obligated to order tests for anesthesia management for a low-risk surgery”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Results > Domains reported not relevant
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“anesthesiologists noted that there was a problem with their inability to cancel tests ordered by the attending surgeon, because they did not know the initial reasoning behind the surgeon ordering the test”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Results > Key themes identified within relevant domains
plaindirect- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Key beliefs were identified within these domains including: conflicting comments about who was responsible for the test-ordering (Social/professional role and identity);”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Abstract > Results
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There was considerable disagreement as to whether time constraint was a factor in test ordering practice.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Results > Key themes identified within relevant domains
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Both anesthesiologist and surgeons reported that it was very easy to order any pre-operative test they wanted—they just ticked a box on the admitting forms”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Results > Key themes identified within relevant domains
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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- Probably not a substantial claim. 68
- It may state two separate claims as one. 34
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“There has been a large body of work reporting pre-operative testing practices [2,4,6,10,31-33].”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Discussion
What the sources say
- Supportedcites [2] Thanh NX, Rashiq S, Jonsson E: Routine preoperative electrocardiogram and chest x-ray prior to elective surgery in Alberta, Canada. Canadian Journal of Anesthesia/Journal canadien d’anesthqsie. 2010, 57: 127-33. 10.1007/s12630-009-9233-4. source
The paper identifies itself as reporting utilization patterns of routine preoperative ECG and chest x-ray testing in Alberta (Introduction). Its Discussion reports the testing rates and how they vary across surgeries, making it an example of work on preoperative testing practices. (LLM, conf=0.91)
- Not checked yetcites [4] Schein OD, Katz J, Bass EB, Tielsch JM, Lubomski LH, Feldman MA, Petty BG, Steinberg EP: The value of routine preoperative medical testing before cataract surgery. N Engl J Med. 2000, 342 (3): 168-175. 10.1056/NEJM200001203420304. source
- Not checked yetcites [6] Chung F, Yuan H, Yin L, Vairavanathan S, Wong DT: Elimination of preoperative testing in ambulatory surgery. Anesth Analg. 2009, 108: 467-10.1213/ane.0b013e318176bc19. source
- Not checked yetcites [10] Bryson GL, Wyand A, Bragg PR: Preoperative testing is inconsistent with published guidelines and rarely changes management [Les tests preoperatoires ne correspondent pas aux directives publiees et modifient rarement la ligne de conduite]. Canadian Journal of Anesthesia. 2006, 53: 236-41. 10.1007/BF03022208. source
- Supportedcites [31] Imasogie N, Wong DT, Luk K, Chung F: Elimination of routine testing in patients undergoing cataract surgery allows substantial savings in laboratory costs. A brief report [L'elimination des tests de routine, avant l'operation de la cataracte, permet de reduire de facon importante les depenses de laboratoire. Un rapport sommaire.]. Canadian Journal of Anesthesia. 2003, 50: 246-8. 10.1007/BF03017792. source
The Methods and Results describe the paper’s own comparison of routine preoperative testing practices before and after a policy change in cataract surgery patients. As one of several citations attached to the broad statement, this paper is an example of work reporting those practices; it need not establish the size of the literature on its own. (LLM, conf=0.88)
- Supportedcites [32] Finegan BA, Rashiq S, McAlister FA, O'Connor P: Selective ordering of preoperative investigations by anesthesiologists reduces the number and cost of tests. Canadian Journal of Anesthesia/Journal canadien d'anesthqsie. 2005, 52: 575-80. 10.1007/BF03015765. source
The paper studies preoperative test-ordering practices and, in its References (page not specified), lists numerous earlier studies of preoperative testing, screening, and ordering guidelines. This supports the broad background statement that substantial work has reported on those practices. (LLM, conf=0.88)
- Supportedcites [33] Archer C, Levy AR, McGregor M: Value of routine preoperative chest x-rays: a meta-analysis. Canadian Journal of Anesthesia/Journal canadien d'anesthqsie. 1993, 40: 1022-7. 10.1007/BF03009471. source
The introduction (Key words section) says numerous studies addressed routine preoperative chest radiography, and the Methods section identifies 21 studies involving 14,390 patients. This supports the broad claim that a substantial body of work reports on preoperative testing, although this source focuses specifically on chest x-rays. (LLM, conf=0.91)
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Supported
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“It became apparent after these six interviews the strong influence surgeons had on the test ordering practice of the anesthesiologists and we decided to include them in the study.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Methods > Participants
boosteddirect- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The medical directive at our hospital is that the surgeon orders the tests.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Results > Key themes identified within relevant domains
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“some surgeons noted that pre-operative test ordering was the responsibility of the anesthesiologists”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Results > Key themes identified within relevant domains
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The interesting thing about the team influence is that although anesthesiologists and surgeons greatly influence whether pre-operative test are ordered by another team member, these clinicians rarely have direct contact with one another and communication is difficult.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Discussion
plaincorrelational- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Reducing routine tests would save money.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Results > Key themes identified within relevant domains
hedgeddirect- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There is nothing in my clinic environment that influences whether I order tests or not.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Results > Key themes identified within relevant domains
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“They stated that routine testing may result in false positives that require investigation, and reducing test ordering would avoid unnecessary investigations and delays.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Results > Key themes identified within relevant domains
hedgedconditional- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Reducing tests may delay or cancel a patient's surgery.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Results > Key themes identified within relevant domains
hedgedconditional- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Sixteen participants, eleven anesthesiologists (9 male; 2 female) and five surgeons (all males), from community (n = 3) and academic hospitals (n = 5) in six health regions throughout Ontario were recruited to participate in the semi-structured interviews.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Results > Participants
plainn = 16- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“I don't need to see an ECG or CXR to do my job.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Results > Key themes identified within relevant domains
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Further, while most agreed that they are motivated to reduce ordering unnecessary tests (Motivation and goals), there was still a report of a gap between their motivation and practice (Behavioural regulation).”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Abstract > Results
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Respondents reported that hospitals commonly either failed to identify which group was specifically responsible for test ordering or identified surgeons as the group responsible for test ordering.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Discussion
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The opinions of others do/do not influence my decision to order routine tests.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Results > Key themes identified within relevant domains
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“It's difficult to cancel because it's time consuming to track down the doctor.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Results > Key themes identified within relevant domains
plaindirectSingle case- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“several anesthesiologists stated that they should have complete autonomy as to what tests should be ordered”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Results > Key themes identified within relevant domains
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: fails — The paper’s conclusions may not depend on it.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“They stated that they rely on the anesthesiologists to order the necessary pre-operative tests and listen to their other team member before making a decision regarding what tests to order”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Results > Key themes identified within relevant domains
plaindirect- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“others mentioned that they were the most responsible physician in the operating room and as such had the ultimate responsibility to understand the whole picture”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Results > Key themes identified within relevant domains
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“I'm reluctant to cancel test ordered by other physicians.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Results > Key themes identified within relevant domains
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“They also noted that because they work with a team there is often an understanding among their colleagues as to what tests are required and they tend to be conservative and order more, to cater for majority views”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Results > Key themes identified within relevant domains
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Reducing routine tests would result in little or not change in outcomes.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Results > Key themes identified within relevant domains
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Time is/is not a factor in my decision to not order tests.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Results > Key themes identified within relevant domains
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“Yet, the anesthesiologists and surgeons interviewed report this finding as accurate and is further supported by evidence documented by Bryson et al.[29].”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Discussion
What the sources say
- Not checked yetcites [29] Bryson GL, Wyand A, Bragg PR: Preoperative testing is inconsistent with published guidelines and rarely changes management. Canadian Journal of Anesthesia/Journal canadien d'anesthqsie. 2006, 53: 236-41. 10.1007/BF03022208. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Reducing routine tests may result in missing an underlying condition that may complicate surgery/recovery.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Results > Key themes identified within relevant domains
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The majority of anesthesiologists and surgeons were aware of the guidelines and knew they were supported by evidence-based research”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Results > Domains reported not relevant
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We need policy that takes the test ordering out of the hands of the surgeons.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Results > Key themes identified within relevant domains
plainSingle case- Asserted: fails — The authors may not put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The authors may not put it forward as true. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Tests are ordered routinely because there pretty cheap.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Results > Key themes identified within relevant domains
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Both anesthesiologist and surgeons agreed that routine tests are a waste of time and money, unnecessary, and rarely provide any useful information.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Results > Key themes identified within relevant domains
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The clinicians’ experience as a specialist ranged in years from 2.5 to 22 (mean ± SD, 10.72 ± 5.16).”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Results > Participants
plainn = 16- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Yet, they also mentioned that routine testing saves patients' time and if routine tests are not ordered, a patient's surgery may get cancelled or miss an underlying condition that may complicate surgery and ensures the patient is fit for the surgery.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Results > Key themes identified within relevant domains
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Reducing routine tests would save patients' time.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Results > Key themes identified within relevant domains
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Both anesthesiologists and surgeons mentioned if hospitals made sure that all pre-operative testing was conducted by only anesthesiologists and took the ordering out of the hands of the surgeons, unnecessary routine testing could be reduced.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Results > Key themes identified within relevant domains
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“A total of 459 utterances from the 16 interviews were coded into the 12 domains.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Results > Interrater reliability
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“I don't play a role in the ordering of tests.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Results > Key themes identified within relevant domains
plainSingle case- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The Medical directive at this hospital dictates that no routine testing/routine testing for low-risk surgeries.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Results > Key themes identified within relevant domains
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Because you work with a group we have to come to an agreement as to what test are required.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Results > Key themes identified within relevant domains
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Often, tests were ordered by an anesthesiologist based on who may be the attending anesthesiologist on the day of surgery while surgeons ordered tests they thought anesthesiologists may need (Social influences).”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Abstract > Results
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“I am confident that I can perform a pre-op assessment on a low-risk patient without pre-op tests.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Results > Key themes identified within relevant domains
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“If tests are ordered I never/sometimes/always review them.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Results > Key themes identified within relevant domains
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“but mentioned that no one would question their request for certain tests; staff would just follow the surgeons’ requests”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Results > Key themes identified within relevant domains
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“I order test I feel are unnecessary because my conservative colleague may be in the OR the day of the surgery and want to see the routine test that I would not.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Results > Key themes identified within relevant domains
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“I can't cancel tests that were ordered by another physician.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Results > Key themes identified within relevant domains
plainSingle case- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Reducing routine testing would avoid unnecessary investigation.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Results > Key themes identified within relevant domains
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“they made conflicting comments as to who exactly was responsible for ordering the pre-operative tests and responses within each professional group varied”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Results > Key themes identified within relevant domains
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Patient emotions do/do not influence whether or not I order routine tests.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Results > Key themes identified within relevant domains
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“It's very easy for me to cancel/not order tests.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Results > Key themes identified within relevant domains
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“I prefer to have routine tests for patient having general anesthesia.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Results > Key themes identified within relevant domains
plainSingle case- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“My Colleagues agree/do not agree with my opinion about Pre-op testing.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Results > Key themes identified within relevant domains
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“they stated that there was no set of specific skills required to order pre-operative test and that nurses, general practitioners, and other physicians (internists) can order them if appropriately trained”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Results > Domains reported not relevant
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“It's very easy for me to order tests.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Results > Key themes identified within relevant domains
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“It's difficult to cancel/not order because most often the tests are completed before I see the patient.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Results > Key themes identified within relevant domains
plaindirectSingle case- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Further the anesthesiologists and surgeons interviewed appear to lend credence to this report.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Discussion
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it.
In the paper
“The Theoretical Domains Framework (TDF) can be used to inform the choice of potential behaviour change techniques to develop interventions as well as to investigate determinants of behaviour [20].”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Background
What the sources say
- Not checked yetcites [20] Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A: Making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Saf Health Care. 2005, 14: 26-10.1136/qshc.2004.011155. source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Two pilot interviews were used to formulate a coding strategy. The first pilot interview was coded by two researchers in tandem to develop the coding strategy, and the second was used to ensure the two coders were comfortable with the strategy developed from the first.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Methods > Analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Two researchers (AMP, RI) coded interview participants’ responses into the relevant theoretical domains.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Methods > Analysis
plainn = 2- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Additionally, in an attempt to avoid premature saturation, we asked the participants to recommend additional anesthesiologists with differing opinions.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Methods > Participants
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“A randomized control study (RCT) of over 19,000 cataract patients found no benefit to routine pre-operative medical testing when stratified according to age, gender, or race of the patient, and most abnormalities in laboratory values could be predicted from patient’s history and physical exam [4].”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Background
What the sources say
- Not checked yetcites [4] Schein OD, Katz J, Bass EB, Tielsch JM, Lubomski LH, Feldman MA, Petty BG, Steinberg EP: The value of routine preoperative medical testing before cataract surgery. N Engl J Med. 2000, 342 (3): 168-175. 10.1056/NEJM200001203420304. source
plainn = 19,000- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“However, many pre-operative tests are routinely ordered for apparently healthy patients without any clinical indication, and the subsequent test results are rarely used [2].”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Background
What the sources say
- Not checked yetcites [2] Thanh NX, Rashiq S, Jonsson E: Routine preoperative electrocardiogram and chest x-ray prior to elective surgery in Alberta, Canada. Canadian Journal of Anesthesia/Journal canadien d’anesthqsie. 2010, 57: 127-33. 10.1007/s12630-009-9233-4. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Michie et al. [20] applied a systematic consensus approach to develop a framework grounded in psychological theory that simplifies theories relevant to behaviour change. The consensus identified 12 theoretical domains from 33 theories and 128 constructs that may explain health-related behaviour change.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Background
What the sources say
- Not checked yetcites [20] Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A: Making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Saf Health Care. 2005, 14: 26-10.1136/qshc.2004.011155. source
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Subsequent coding of the remaining interviews was completed independently and Fleiss’s Kappa (κ) was calculated for all domains and interviews to assess whether the two researchers coded the same response into the same domain [26,27].”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Methods > Analysis
What the sources say
- Not checked yetcites [26] Fleiss JL: Measuring nominal scale agreement among many raters. Psychol Bull. 1971, 76: 378- source
- Not checked yetcites [27] Fleiss JL: The measurement of interrater agreement. Statistical methods for rates and proportions. 1981, 2: 212-36.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“They advocate that investigations should not be ordered on a routine basis, but should be based on the patient’s health status, drug therapy, and with consideration to the proposed surgical intervention [7].”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Background
What the sources say
- Not checked yetcites [7] Merchant R, Bosenberg C, Brown K, Chartrand D, Dain S, Dobson J, Kurrek M, LeDez K, Morgan P, Penner M: Guidelines to the Practice of Anesthesia Revised Edition 2011 - Guide d’exercice de l'anesthésie Édition révisée 2011. Canadian Journal of Anesthesia. 2011, 58: 74-107. 10.1007/s12630-010-9416-z. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“After pilot testing with two anesthesiologists, wording of some questions from the original TDF had to be modified to fit the context of the behaviour. Subsequent piloting with a further two anesthesiologists resulted in additional wording changes to enhance clarity of one question”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Methods > Interview topic guide
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“They reported no significant difference between rates of perioperative adverse events and the rates of adverse events 30 days after surgery between groups [6].”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Background
What the sources say
- Not checked yetcites [6] Chung F, Yuan H, Yin L, Vairavanathan S, Wong DT: Elimination of preoperative testing in ambulatory surgery. Anesth Analg. 2009, 108: 467-10.1213/ane.0b013e318176bc19. source
plainn = 1,057- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Bryson reported that surgeons were responsible for 80% of the test ordering that were in non-compliance with the Ontario Pre-operative Testing Grid at the Ottawa Hospital [10].”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Background
What the sources say
- Not checked yetcites [10] Bryson GL, Wyand A, Bragg PR: Preoperative testing is inconsistent with published guidelines and rarely changes management [Les tests preoperatoires ne correspondent pas aux directives publiees et modifient rarement la ligne de conduite]. Canadian Journal of Anesthesia. 2006, 53: 236-41. 10.1007/BF03022208. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Briefly, three factors were considered when identifying key domains: frequency of the beliefs across interviews; presence of conflicting beliefs; and perceived strength of the beliefs impacting the behaviour.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Methods > Analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“A surgeon may order the tests ‘in case’ the attending anesthesiologist needs it and in hopes that the patient will move smoothly through the pre-admission assessment process.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Discussion
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“These beliefs identify potential individual, team, and organisation targets for behaviour change interventions to reduce unnecessary routine test ordering.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Abstract > Conclusion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence.
- Rests on an assumption: Changing the beliefs identified in this study would change clinicians' pre-operative test-ordering behaviour.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Responses that were coded in different domains by the researchers were discussed to establish consensus. In instances where single domain allocation agreement could not be reached, researchers agreed that the response could be placed in both domains.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Methods > Analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“They found marked differences in the professionals’ perceptions around issues of role authority, motivation, and value with respect to communication among team members.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Discussion
What the sources say
- Not checked yetcites [30] Lingard L, Reznick R, DeVito I, Espin S: Forming professional identities on the health care team: discursive constructions of the ‘other’ in the operating room. Medical education. 2002, 36: 728-34. 10.1046/j.1365-2923.2002.01271.x. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The anesthesiologist who sees the patient prior to the surgery orders the tests ‘in case’ the attending anesthesiologist needs them and could not cancel tests ordered by the surgeon because they have not identified the reason for ordering the tests.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The likelihood that an alternative professional group would review another’s guidelines is rare because they struggle to keep up-to-date with their own ever-changing evidence-based practice.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Further, although initial interrater reliability was calculated, all disagreements between researchers were resolved through consensus.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Results > Interrater reliability
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“This strategy was reviewed by the second researcher (RI) to ensure accurate representation of content.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Methods > Analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“A directive by hospital management that is supported by the professional groups involved, as to which group holds the role and responsible for ordering the tests required for anesthesia management would likely reduce confusion and encourage greater consistency in test ordering practices.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Discussion
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“One researcher (AMP) generated statements that represented the specific beliefs from each participant’s responses that captured the core thought and continued this process for every response.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Methods > Analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Relevant domains were identified through consensus discussion between the two researchers (AMP, RI) and confirmed by a health psychologist (JJF).”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Methods > Analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“Bryson et al. was the only paper reviewed to suggest a need to change ‘established behaviour’ that should include not only anesthesiologists but surgical colleagues and clinic personnel [10].”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Discussion
What the sources say
- Not checked yetcites [10] Bryson GL, Wyand A, Bragg PR: Preoperative testing is inconsistent with published guidelines and rarely changes management [Les tests preoperatoires ne correspondent pas aux directives publiees et modifient rarement la ligne de conduite]. Canadian Journal of Anesthesia. 2006, 53: 236-41. 10.1007/BF03022208. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This study is one of the first to attempt to examine why anesthesiologists and surgeons order routine pre-operative tests when no clinical indicators exist.”
- Also stated in: § Conclusion · plain
“This study is one of the first to attempt to examine why anesthesiologists and surgeons order routine pre-operative tests.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper may give no reason why it holds.
- Also stated in: § Conclusion · plain
In the paper
“A systematic review by Munro et al. reported that the value of pre-operative ECGs in predicting postoperative cardiac complications seems to be very small, and the indirect evidence suggests that routinely recorded pre-operative ECGs as a baseline measure are likely to be of little or no value [34].”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Discussion
What the sources say
- Not checked yetcites [34] Munro J, Booth A, Nicholl J: Routine preoperative testing: a systematic review of the evidence. Health Technology Assessment (Winchester, England). 1997, 1 (12): 1-62.
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Although their study looked at four professional groups, their findings are consistent with ours in identifying a problem in the lack of clarity relating to roles of surgeons and anesthesiologists.”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“They suggest that communications of these team members are probably motivated by some combination of concern for the patient, the day’s schedule, ethical issues, economic implications, and many other factors [30]”
§ Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests > Discussion
What the sources say
- Not checked yetcites [30] Lingard L, Reznick R, DeVito I, Espin S: Forming professional identities on the health care team: discursive constructions of the ‘other’ in the operating room. Medical education. 2002, 36: 728-34. 10.1046/j.1365-2923.2002.01271.x. source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
The paper relies on this without support.
Changing the beliefs identified in this study would change clinicians' pre-operative test-ordering behaviour.
“These beliefs identify potential individual, team, and organisation targets for behaviour change interventions to reduce unnecessary routine test ordering.”
The paper relies on this without support.
The TDF domains and specific beliefs elicited in interviews capture the determinants of pre-operative test-ordering behaviour.
“In this study, we used the TDF to systematically examine the beliefs of anaesthesiologists and surgeons about the use of pre-operative testing routinely ordered for anesthesia management in healthy patients undergoing low-risk surgical procedures.”
The paper relies on this without support.
Participants' self-reported beliefs accurately reflect their actual test-ordering behaviour.
“An interview topic guide was developed based on the Theoretical Domains Framework to elicit beliefs about each domain for the behaviour”
The paper relies on this without support.
Translating guidelines into clinical practice is difficult when one healthcare professional has decision-making autonomy, and even more so when a group of professionals are responsible, as with pre-operative test ordering.
“Translating guidelines into clinical practice is notoriously difficult when one healthcare professional has decision-making autonomy; it can be even more so when a group of professionals are responsible, as is the case with pre-operative test ordering.”
The paper relies on this without support.
The frequency with which a domain is mentioned by participants reflects its importance as an influence on test-ordering behaviour.
“Of the seven identified the five that appeared to be the most influential, based on the frequency of utterances coded and content of the responses, were Social/professional role and identity, Beliefs about capabilities, Beliefs about consequences, Environmental context and resources, and Social influences.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The cited source says what the claim attributes to it.
In the citing paper
“The framework has been used in a number of studies and was demonstrated to be useful for the development of qualitative [32,33] and quantitative [34-36] measurement tools to assess potential implementation behavior determinants.”
From Discriminant content validity of a theoretical domains framework questionnaire for use in implementation research (2014) · cites this paper as [32]
The cited source says what the claim attributes to it.
In the citing paper
“The following three criteria have been applied in published studies: (1) relatively high frequency of specific beliefs and/or themes (not relevant to focus group interviews); (2) presence of conflicting beliefs; and (3) evidence of strong beliefs that may affect the target behaviour [28].”
From A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems (2017) · cites this paper as [28]
The cited source says what the claim attributes to it.
In the citing paper
“Reliability between the two coders may be assessed by an inter-rater reliability coefficient, for example through assessing a kappa score across all domains [28].”
From A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems (2017) · cites this paper as [28]
In the citing paper
“The framework has been used in a number of studies and was demonstrated to be useful for the development of qualitative [32,33] and quantitative [34-36] measurement tools to assess potential implementation behavior determinants.”
From Discriminant content validity of a theoretical domains framework questionnaire for use in implementation research (2014) · cites this paper as [32]
Citations
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Everitt, B. S., & Fleiss, J. L. (1981) · Biometrics · doi:10.2307/2530193 · Cited by 9,034
Measuring nominal scale agreement among many raters.
Fleiss, J. L. (1971) · Psychological Bulletin · doi:10.1037/h0031619 · Cited by 8,733
Audit and feedback: effects on professional practice and healthcare outcomes
Ivers, N., Jamtvedt, G., Flottorp, S., Young, J. M., Odgaard-Jensen, J., French, S. D., O'Brien, M. A., Johansen, M., Grimshaw, J., & Oxman, A. D. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd000259.pub3 · Cited by 5,485
Self-citationCane, J., O’Connor, D., & Michie, S. (2012) · Implementation Science · doi:10.1186/1748-5908-7-37 · Cited by 4,888 · cited 1×
“This article is one in a series of articles documenting the development and use of the Theoretical Domains Framework (TDF) to advance the science of implementation research [21-24].”
BackgroundMaking psychological theory useful for implementing evidence based practice: a consensus approach
Michie, S. (2005) · Quality and Safety in Health Care · doi:10.1136/qshc.2004.011155 · Cited by 3,440
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Self-citationMichie, S., Johnston, M., Francis, J., Hardeman, W., & Eccles, M. (2008) · Applied Psychology · doi:10.1111/j.1464-0597.2008.00341.x · Cited by 1,789
Self-citation
Research works printed but not linked: 3
- Badner N, Bryson G, Kashin B, Mensour M, Riegert D, van Vlymen J, Wong D: Ontario Preoperative testing grid. 2004, Available from URL; http://gacguidelines.ca/pdfs/tools/Ontario%20Preoperative%20Testing%20Grid.pdf , Endorsed by the Ontario Guidelines Advisory Committee,
- Hux J: Preoperative testing prior to elective surgery. Hospital Quarterly. 2003, 6: 27-
- Bryson GL, Wyand A, Bragg PR: Preoperative testing is inconsistent with published guidelines and rarely changes management. Canadian Journal of Anesthesia/Journal canadien d'anesthqsie. 2006, 53: 236-41. 10.1007/BF03022208. · DOI · Paper page
Cited by
Sorted by citations
Atkins, L., Francis, J., Islam, R., O’Connor, D., Patey, A., Ivers, N., Foy, R., Duncan, E. M., Colquhoun, H., Grimshaw, J. M., et al. (2017) · Implementation Science · doi:10.1186/s13012-017-0605-9 · Cited by 3,819
“Examples of interview studies include investigating facilitators and barriers to offering a family intervention to families of people with schizophrenia [24], transfusing with red blood cells [25, 26], discussing human papillomavirus (HPV) vaccination with patients [27], routinely ordering pre-operative tests [28], er…”
BackgroundMethodSelf-citationImplementation Mapping: Using Intervention Mapping to Develop Implementation Strategies
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Metadata
- Authors
- the Canada PRIME Plus Team, Patey, A. M., Islam, R., Francis, J. J., Bryson, G. L., & Grimshaw, J. M.
- Affiliations
- Ottawa Hospital Research Institute (CA)
- University of Aberdeen (GB)
- University of Ottawa (CA)
- Corresponding author
- Patey, Andrea M
- Venue
- Implementation Science
- Published
- 2012-06-09
- Volume
- 7
- Issue
- 1
- Pages
- 52-52
- ISSN
- 1748-5908 (ISSN-L)
- PMC
- PMC3522997
- OpenAlex
- W2094924948
- Semantic Scholar
- cee40a4133c9a22af3d2838f9ea7aa7b73e1c6b2
- Cited by
- 237
- References
- 49
- Citations by year
- 2026: 10 · 2025: 15 · 2024: 34 · 2023: 26 · 2022: 26 · 2021: 25 · 2020: 13 · 2019: 23 · 2018: 13 · 2017: 17 · 2016: 10 · 2015: 9 · 2014: 12 · 2013: 4
- FWCI
- 14.20
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Implementation Science (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- City Research Online (City University London) (acceptedVersion)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by)
- Aberdeen University Research Archive (Aberdeen University) (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- uO Research (University of Ottawa) (submittedVersion, public-domain)
- Funders
- Canadian Institutes of Health Research
- Topics
- Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
- Keywords
- preoperative screening, low-risk surgery, Theoretical Domains Framework, clinician behavior change, anesthesiologists, surgeons, clinician perceptions, behaviour change interventions, overuse of diagnostic tests
- MeSH terms
- Anesthesiology, Clinical Competence, Decision Making, Environment, Female, Humans, Interprofessional Relations, Interviews as Topic, Health Knowledge, Attitudes, Practice, Male, Medicine, Motivation, Ontario, Perception, Physicians, Preoperative Care, Risk Factors, Professional Role
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-10-06, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-06 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Cited sources are checked with a language model’s help (gpt-6-sol).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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