Pilot testing of a decision support tool for patients with abdominal aortic aneurysms.
OBJECTIVE
Patients with abdominal aortic aneurysms (AAAs) who are surgical candidates have as many as three options: open surgery, endovascular surgery, or no surgery. As with all treatment decisions, informed patient preferences are critical. Decision support tools have the potential to better inform patients about the risks and benefits associated with each treatment option and to empower patients to participate meaningfully in the decision-making process. The objective of this study was to develop and pilot test a decision support tool for patients with AAAs.


METHODS
We developed a personalized, interactive, computer-based decision support tool reflecting the most current outcomes data and input from surgeons and patients. We piloted the tool with AAA repair candidates who used the tool prior to meeting with their surgeon. Patients were recruited from a university-based vascular surgery clinic and affiliated VA hospital clinic. To determine feasibility and acceptability, the following outcomes were measured: (1) percent of patients who agreed to participate, (2) length of time required to use the tool, (3) the amount of assistance required to use the tool, and (4) patients' opinions on the acceptability of the tool. To assess effectiveness of the tool, we measured change in knowledge and decisional conflict pre- and post-tool using the paired t-test.


RESULTS
One hundred percent of patients who were approached (n = 12) agreed to participate in the study. The tool was administered in a median time of 35 minutes (range, 25-45 minutes), and all patients were able to navigate the program with minor technical assistance. Mean knowledge scores increased from 56% to 90% (P = .005), and decisional conflict scores decreased from 29% to 8% (P = .04). Overall, patients reported that the program content was balanced across treatment options, presented information clearly and concisely, helped them to organize their thoughts about the decision, and prepared them to talk to their surgeon about what mattered most to them.


CONCLUSIONS
Preliminary evidence suggests that use of an evidence-based AAA decision support tool is feasible and acceptable to patients, increases knowledge, and decreases decisional conflict. Widespread use of such a tool might improve the content and quality of informed consent for this difficult treatment decision.
Department of Surgery, Yale University School of Medicine, Robert Wood Johnson Clinical Scholars Program, New Haven, Conn 06520, USA. loren.berman@yale.edu
Loren
L
Berman
Leslie
L
Curry
Carolyn
C
Goldberg
Richard
R
Gusberg
Liana
L
Fraenkel
D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001291:Attitude of Health Personnel; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D002755:Choice Behavior; D003220:Conflict, Psychological; D003237:Connecticut; D020000:Decision Support Systems, Clinical; D057510:Endovascular Procedures / Q000009:adverse effects; D019317:Evidence-Based Medicine; D005240:Feasibility Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D010358:Patient Participation; D017060:Patient Satisfaction; D018579:Patient Selection; D010817:Physician-Patient Relations; D010865:Pilot Projects; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors