title: Patient risk perceptions for carotid endarterectomy: which patients are strongly averse to surgery?
abstract: OBJECTIVE
  Patient risk perception for surgery may be central to their willingness to undergo surgery. This study examined potential factors associated with patient aversion of surgery.
  
  
  METHODS
  This is a secondary data analysis of a prospective cohort study that examined patients referred for evaluation of carotid artery stenosis at five Veterans Affairs Medical Centers. The study collected demographic, clinical, and psychosocial information related to surgery. This analysis focused on patient response to a question assessing their aversion to surgery.
  
  
  RESULTS
  Among the 1065 individuals, at the time of evaluation for carotid endarterectomy (CEA), 66% of patients had no symptoms, 16% had a transient ischemic attack, and 18% had stroke. Twelve percent of patients referred for CEA evaluation were averse to surgery. In adjusted analyses, increased age, black race, no previous surgery, lower level of chance locus of control, less trust of physicians, and less social support were significantly related to greater likelihood of surgery aversion among individuals referred for CEA evaluation. Patient degree of medical comorbidity and a validated measure of preoperative risk score were not associated with increased aversion to surgery.
  
  
  CONCLUSIONS
  In previous work, aversion to CEA was associated with lack of receipt of CEA even after accounting for patient clinical appropriateness for surgery. We identified important patient characteristics associated with aversion to CEA. Interventions designed to assist patient decision making should focus on these more complex factors related to CEA aversion rather than the simple explanation of clinical usefulness.
authors.affiliation: Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, NC 27705, USA. hboswort@acpub.duke.edu
authors.forename: Hayden B
authors.initials: HB
authors.lastname: Bosworth
authors.forename: Karen M
authors.initials: KM
authors.lastname: Stechuchak
authors.forename: Steven C
authors.initials: SC
authors.lastname: Grambow
authors.forename: Eugene Z
authors.initials: EZ
authors.lastname: Oddone
mesh_terms: D000368:Aged; D016894:Endarterectomy, Carotid / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010361:Patients / Q000523:psychology; D010465:Perception; D012306:Risk; D016312:Treatment Refusal / Q000523:psychology*