title: A decision aid regarding treatment options for patients with an asymptomatic abdominal aortic aneurysm: a randomised clinical trial.
abstract: OBJECTIVE
  Abdominal aortic aneurysm patients tend to be informed inconsistently and incompletely about their disorder and the treatment options open to them. The objective of this trial was to evaluate whether these patients are better informed and experience less decisional conflict regarding their treatment options after viewing a decision aid.
  
  
  METHODS
  A six-centre, randomised clinical trial comparing a decision aid plus regular information versus regular information from the surgeon.
  
  
  METHODS
  Included patients had recently been diagnosed with an asymptomatic abdominal aortic aneurysm at least 4 cm in diameter. The decision aid consisted of a one-time viewing of an interactive CD-ROM elaborating on elective surgery versus watchful waiting. Generally, the decision aid advised patients with aneurysms less than 5.5 cm to agree to watchful waiting, for larger aneurysms the decision aid provided insight into the balance of benefit and harm of surgical and conservative approaches, taking into account age, co-morbidity and size of the aneurysm. The primary outcome was patient decisional conflict measured at 1 month follow-up (Decisional Conflict Scale). Secondary outcomes were patient knowledge, anxiety and satisfaction.
  
  
  RESULTS
  In 178 aneurysm patients, decisional conflict scores did not differ significantly between the decision aid and the regular information groups (22 vs. 24 on the 0-100 Decisional Conflict Scale; p = .33). Patients in the decision aid group had significantly better knowledge (10.0 vs. 9.4 out of 13 points; p = .04), whereas anxiety levels (4.4 and 5.0 on a 0-21 scale; p = .73) and satisfaction scores (74 and 73 on a 0-100 scale; p = .81) were similar in both groups.
  
  
  CONCLUSIONS
  In addition to regular patient-surgeon communication, a decision aid helps to share treatment decisions with abdominal aortic aneurysm patients by increasing their knowledge about the disorder and available treatment options without raising anxiety levels; however, it does not reduce decisional conflict, nor does it improve satisfaction.
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: A M
authors.initials: AM
authors.lastname: Knops
authors.affiliation: Department of Quality Assurance and Process Innovation, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: a.goossens@amc.nl.
authors.forename: A
authors.initials: A
authors.lastname: Goossens
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: D T
authors.initials: DT
authors.lastname: Ubbink
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Balm
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: M J W
authors.initials: MJ
authors.lastname: Koelemay
authors.affiliation: Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
authors.forename: A C
authors.initials: AC
authors.lastname: Vahl
authors.affiliation: Department of Surgery, Red Cross Hospital, Beverwijk, The Netherlands.
authors.forename: A J
authors.initials: AJ
authors.lastname: de Nie
authors.affiliation: Department of Surgery, Medical Center Alkmaar, Alkmaar, The Netherlands.
authors.forename: P J
authors.initials: PJ
authors.lastname: van den Akker
authors.affiliation: Department of Surgery, Flevo Hospital, Almere, The Netherlands.
authors.forename: M C M
authors.initials: MC
authors.lastname: Willems
authors.affiliation: Department of Surgery, Tergooi Hospitals, Hilversum, The Netherlands.
authors.forename: N A
authors.initials: NA
authors.lastname: Koedam
authors.affiliation: Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: J C J M
authors.initials: JC
authors.lastname: de Haes
authors.affiliation: Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: P M M
authors.initials: PM
authors.lastname: Bossuyt
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: D A
authors.initials: DA
authors.lastname: Legemate
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016251:CD-ROM; D003661:Decision Support Techniques; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D010353:Patient Education as Topic; D010358:Patient Participation; D017060:Patient Satisfaction; D011788:Quality of Life; D011795:Surveys and Questionnaires; D057832:Watchful Waiting
keywords: Abdominal aortic aneurysm; Decision support techniques; Elective surgery; Watchful waiting