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Session:: ePosters-Sun130-M8: Benign Abdominal

EP525 - Quantifying Decisional Conflict in the Management of Recurrent Left-Sided Diverticulitis

Sunday, May 10, 2026
2:02 PM - 2:07 PM ET

    ePoster Presenter(s)

  • Marissa C. Kuo, MD

    General Surgery Resident
    Vanderbilt University Medical Center
    Vanderbilt University Medical Center
    Nashville, TN, United States

    Disclosure information not submitted.

    • Author(s)

  • Samuel A. Younan, MD

    Colorectal Research Fellow
    Department of Colorectal Surgery at Vanderbilt University Medical Center
    Vanderbilt University Medical Center
    Nashville, TN, United States

    Disclosure information not submitted.

  • Aimal Khan, MD

    Assistant Professor of Surgery
    Vanderbilt University Medical Center
    Vanderbilt Health
    Nashville, TN, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • Alexander T. Hawkins, MD, MPH

    Associate Professor
    Vanderbilt University Medical Center
    Vanderbilt University Medical Center
    Nashville, TN, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • Daniel I. Chu, MD, MSPH (he/him/his)

    Professor and Division Director
    University of Alabama at Birmingham
    University of Alabama at Birmingham
    Birmingham, AL, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • KC

    Kerri Cavanaugh, MD MHS

    Associate Professor of Medicine
    Vanderbilt University Medical Center
    Nashville, Tennessee, United States

    Disclosure information not submitted.

  • Matthew Mutch, MD

    Professor of Surgery
    Washington University
    Washington University School of Medicine
    St Louis, Missouri, United States

    Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.
Alexander T. Hawkins, MD, MPH: This individual has no financial relationships with ineligible companies.
Daniel I. Chu, MD, MSPH: This individual has no financial relationships with ineligible companies.
Purpose/Background: Despite decades of study, there is no evidence to suggest any long-term difference in outcomes between observation and surgery for recurrent uncomplicated diverticulitis. Consequently, treatment decisions are becoming increasingly individualized, with patients playing a greater role in managing their care. This shift may increase decisional conflict for patients, which has been linked to reduced quality of life, heightened anxiety, and depression in other disease processes. We aimed to quantify the degree of decisional conflict and its association with quality of life amongst patients with recurrent left-sided diverticulitis considering colectomy versus observation.

Methods/Interventions: We conducted a prospective, single-institution observational study of patients seen in colorectal surgery clinic for recurrent left-sided diverticulitis between December 2024 and October 2025. Eligible participants were recruited on a voluntary basis and web-based REDCap surveys including the Decisional Conflict Scale (DCS) and the Diverticulitis Quality of Life scale (DV-QoL) were administered. Surveys were all completed prior to any operative intervention. The primary outcome was level of reported decisional conflict. Secondary outcomes of interest included the decision to proceed with colectomy versus observation and reported disease-specific quality of life.

Results/Outcomes: Thirty patients were included in study analysis. 11/30 patients (36.7%) reported a high degree of decisional conflict and 15/30 (50%) of all patients surveyed reported they were unsure about their decision. Overall, 9 patients chose surgery and 21 chose observation. Amongst individuals who chose surgery, 5/9 reported high levels of decisional conflict (55.6%) compared to only 6/21 (28.6%) who elected for observation (p = 0.160). Compared between individuals who elected to proceed with surgery versus those who chose observation, those who chose surgery reported higher scores across all DCS subscales, though a statistically significant difference was only identified in the "Informed" sub-score (41.7 vs. 19.4, p = 0.039), corresponding to the degree to which the respondent feels informed about their options (higher score indicates less informed). In a univariate linear regression model, higher DCS scores were associated with higher DV-QoL scores, corresponding to worse quality of life (p = 0.045).

Conclusion/Discussion: Many patients with recurrent left-sided diverticulitis experience uncertainty when deciding whether to proceed with colectomy. This study is the first to quantify the degree of decisional conflict in this population and results suggest that higher decisional conflict may be linked to worse disease-specific quality of life. Though results are limited by small sample size, this study highlights the need for targeted decision support for patients considering undergoing colectomy for recurrent left-sided diverticulitis.

Table 1
Decisional Conflict Scale (DCS) scores and sub-scores for all participants surveyed by decision type (surgery vs. observation)