A M Knops1, A Goossens2, D T Ubbink1, R Balm1, M J W Koelemay1, A C Vahl3, A J de Nie4, P J van den Akker5, M C M Willems6, N A Koedam7, J C J M de Haes8, P M M Bossuyt9, D A Legemate1. 1. Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. 2. Department of Quality Assurance and Process Innovation, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: a.goossens@amc.nl. 3. Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands. 4. Department of Surgery, Red Cross Hospital, Beverwijk, The Netherlands. 5. Department of Surgery, Medical Center Alkmaar, Alkmaar, The Netherlands. 6. Department of Surgery, Flevo Hospital, Almere, The Netherlands. 7. Department of Surgery, Tergooi Hospitals, Hilversum, The Netherlands. 8. Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands. 9. Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, The Netherlands.
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. DESIGN: 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. CONCLUSION: 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.
RCT Entities:
OBJECTIVE:Abdominal aortic aneurysmpatients 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. DESIGN: 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 aneurysmpatients, 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. CONCLUSION: In addition to regular patient-surgeon communication, a decision aid helps to share treatment decisions with abdominal aortic aneurysmpatients 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: Anne R Cotter; Kim Vuong; Linda Mustelin; Yi Yang; Malika Rakhmankulova; Colleen J Barclay; Russell P Harris Journal: BMJ Open Date: 2017-12-12 Impact factor: 2.692
Authors: Carlo Setacci; Pasqualino Sirignano; Vittorio Fineschi; Paola Frati; Giovanna Ricci; Francesco Speziale Journal: Ann Med Surg (Lond) Date: 2017-02-20
Authors: Aubri S Hoffman; Karen R Sepucha; Purva Abhyankar; Stacey Sheridan; Hilary Bekker; Annie LeBlanc; Carrie Levin; Mary Ropka; Victoria Shaffer; Dawn Stacey; Peep Stalmeier; Ha Vo; Celia Wills; Richard Thomson Journal: BMJ Qual Saf Date: 2018-02-21 Impact factor: 7.418
Authors: Thomas H Wieringa; Rene Rodriguez-Gutierrez; Gabriela Spencer-Bonilla; Maartje de Wit; Oscar J Ponce; Manuel F Sanchez-Herrera; Nataly R Espinoza; Yaara Zisman-Ilani; Marleen Kunneman; Linda J Schoonmade; Victor M Montori; Frank J Snoek Journal: Syst Rev Date: 2019-05-20