How to improve shared decision-making among vascular surgeons and their patients

Introducing hospitals to different decision support tools (DSTs) can improve the level of shared decision-making (SDM) among vascular surgeons and their patients, according to a new study published in the European Journal of Vascular & Endovascular Surgery. Patient knowledge also improved, as did the likelihood that patients might prefer a non-surgical treatment option.

“SDM enhances patients’ satisfaction with the care process, improves the knowledge about their disease and treatment options, decreases anxiety, improves therapy adherence and raises the number of patients who decide upon less invasive treatments,” wrote lead author Fabiënne E. Stubenrouch, MD, a specialist with Amsterdam Medical Center in the Netherlands, and colleagues. “Besides these beneficial effects, there are also legal and ethical obligations to correctly inform patients about their disease and treatment options. In addition, it is known that SDM has no harmful effects such as increased anxiety, decisional conflict, or poorer health outcomes.”

Despite these benefits, Stubenrouch et al. explained, SDM is still somewhat rare among healthcare providers, leading to patients who often receive inconsistent information about the treatment options available to them. The group aimed to see if introducing different DSTs could improve SDM in vascular surgery and, ultimately, improve patient care.

The researchers conducted their analysis in the outpatient clinics of 13 Dutch hospitals. Patients were eligible to be included if they presented at one of those locations with an abdominal aortic aneurysm (AAA), varicose veins, carotid artery stenosis or intermittent claudication (IC) and more than one treatment option was possible.

One of the DSTs introduced for the study was patient decision aids, which detailed different treatment options, asked for patient preferences and examined what they understood about their situation. Another DST the authors introduced was a set of consultation cards and decision cards that clinicians and patients could use together during consultations. Clinicians even practiced using these cards during a three-hour training session involving simulated patient encounters.

At the start of the analysis, the 13 hospitals all consulted their patients as they always had—but every three months, a few hospitals would start implementing the patient decision aids and/or consultation cards. Data was then collected through questionnaires, audio recordings of patient consultations and the decision aid’s content management system.

Overall, the study included 342 patients and nearly 400 recorded consultations. OPTION-5 scores—a way to measure the level of SDM during a given consultation—“significantly improved” after the introduction of these DSTs, increasing from 28.7% to 37.8%. Patient knowledge also increased by a significant margin (a median increase of 13%), and the number of patients choosing a non-surgical treatment option increased from 21.4% to 28.8% among AAA patients and 16% to 32% among IC patients.

“Introducing DSTs promotes SDM between vascular surgical patients and clinicians, improves patient knowledge and increases the choice for non-surgical treatment,” the authors wrote. “Particularly the SDM training for clinicians and the online decision aid for patients appear effective means for promoting SDM. However, there is still room for improvement. More awareness of the concept of SDM and better usage of the tools are necessary for successful implementation.”

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1. Fabiënne E. Stubenrouch, MD; Loes J. Peters, MSc; Sylvana M.L. de Mik, MD, PhD, et al. Improving shared decision-making in vascular surgery: a stepped-wedge cluster-randomised trial. J.ejvs.2022.04.016.

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