Use of qualitative research to analyze patient and clinician decision making in carotid endarterectomy.

Carotid endarterectomy (CEA) is a well-established surgical procedure to reduce a patient's risk of stroke by relieving stenosis of the internal carotid artery. However, the operation is not free from risk and may precipitate a fatal or disabling stroke. Attention in the previous literature has focused on clinicians' decisions about CEA and has given almost no consideration of the patient's perspective. This study describes the use of qualitative research techniques to study patients' and surgeons' perceptions of risk, information needs, and decision-making preferences in relation to investigations and treatment for carotid stenosis. Results of a pilot study are discussed in relation to 5 emerging themes: reducing uncertainty, weighing the odds, the chagrin factor, "whose decision," and gains from surgery. The integration of these emerging themes with the literature on CEA is discussed in relation to the future direction of the project.