The Role of Regret in Extracorporeal Membrane Oxygenation Candidacy Decision-Making.

BACKGROUND: Veno-venous extracorporeal membrane oxygenation (VV ECMO) candidacy decisions are made under substantial uncertainty and are inconsistent. With a team including economist decision-scientists, we applied Regret Theory to hypothesize that ECMO clinicians' perceived past and anticipated regret is an important influence on these decisions and contributes to inconsistency. RESEARCH QUESTION: Does regret influence ECMO candidacy decisions? STUDY DESIGN AND METHODS: This is a secondary analysis of a qualitative semi-structured interview study with 24 ECMO clinicians from various international urban, rural, public, and private ECMO centers conducted between September and December 2024 to elicit clinicians' perceptions on ECMO candidacy decisions. In this study, a team of three investigators (two physicians; one economist) used directed qualitative content analysis, informed by Regret Theory, to examine whether and how clinicians' regret influences these decisions. RESULTS: We identified three themes relating to the role of regret in ECMO candidacy decision-making: First, clinicians prefer utility-based reasoning, but it is often not possible. Second, regret of omission and commission both influence candidacy decisions. Finally, clinicians employ various strategies to minimize past and anticipated regret. INTERPRETATION: We demonstrate that regret plays an influential role in how candidacy decisions are made, which may partly explain known inconsistencies in candidacy decisions within centers.