Effect of a Decision Aid on Agreement Between Patient Preferences and Repair Type for Abdominal Aortic Aneurysm

Abstract

IMPORTANCEPatients with abdominal aortic aneurysm (AAA) can choose open repair or endovascular repair (EVAR). While EVAR is less invasive, it requires lifelong surveillance and more frequent aneurysm-related reinterventions than open repair. A decision aid may help patients receive their preferred type of AAA repair.OBJECTIVE To determine the effect of a decision aid on agreement between patient preference for AAA repair type and the repair type they receive. DESIGN, SETTING, AND PARTICIPANTSIn this cluster randomized trial, 235 patients were randomized at 22 VA vascular surgery clinics. All patients had AAAs greater than 5.0 cm in diameter and were candidates for both open repair and EVAR.

A Careful Consideration of the Effect of a Decision Aid on Agreement Between Patient Preferences and Repair Type for Abdominal Aortic Aneurysm—Reply

“…In Reply Shared decision-making in health care has become a critical part of the patient visit, which necessitates knowledge and dialogue from both the patient as well as the surgeon. Our study sought to assess whether the use of a decision aid distributed to patients with abdominal aortic aneurysms helped to better align their preferences for treatment with what surgery they ultimately received …”

A Careful Consideration of the Effect of a Decision Aid on Agreement Between Patient Preferences and Repair Type for Abdominal Aortic Aneurysm

“…Eid et al assessed the use of a decision aid in helping patients with abdominal aortic aneurysm choose between endovascular or open repair interventions. The authors found that patients who were given the decision aid were significantly more likely to receive their preferred type of intervention, and the majority of patients preferred endovascular repair . We would like to applaud the authors for addressing a lacuna in the literature by providing randomized evidence and would like to know their thoughts on the points we have raised here.…”

“…The relational aspects of surgeon-patient encounter in preoperative evaluation are integral to the genesis of trust, and we question why the authors did not emphasize the irreplaceability of surgeon-patient discussions in the decision-making process. Similarly, the authors posit that the decision aid is easy to implement even in staffing limitations . This may be misleading as decision aids can be associated with longer consultations .…”

“…In essence, a decision aid can assist patients to receive their desired method of abdominal aortic aneurysm repair . We would like to hear the authors’ thoughts on emphasizing decision aids as an adjunct to surgeon-patient discussions, its potential to increase the length of consultations, implementation in a diverse population, and discordance findings.…”

“…To the Editor Despite the current climate of emphasizing shared decision-making in health care, there exists a lack of evidence that using a decision aid can help to better align patient preference and the surgical intervention that is ultimately received. Eid et al assessed the use of a decision aid in helping patients with abdominal aortic aneurysm choose between endovascular or open repair interventions. The authors found that patients who were given the decision aid were significantly more likely to receive their preferred type of intervention, and the majority of patients preferred endovascular repair .…”