Vascular Surgery Decision Support Tools Promote Shared Decision-Making

The use of decision support tools resulted in improved shared decision-making among vascular surgeons and their patients, with improvement in patient knowledge and an increase in patient preference for nonsurgical treatments, according to the results of a study published in the European Journal of Vascular & Endovascular Surgery.

The OVIDIUS (Operative Vascular Intervention Decision-making Improvement Using SDM-tools) study was conducted in the outpatient clinics of 13 hospitals in the Netherlands from January 2018 to February 2021. Investigators evaluated the implementation and effectiveness of decision cards, consultation cards, online patient decision aids, and training on shared decision-making in vascular surgical practice.

Diagnoses among eligible patients included abdominal aortic aneurysm, varicose veins, carotid artery stenosis, or intermittent claudication.  Patients were offered more than 1 treatment option, including not to treat.

The aforementioned decision support tools were developed, and practical consultation trainings were also used. Data were obtained from questionnaires, audio recordings of the consultations, and the decision aid’s content management system. Patients with carotid artery stenosis were eventually excluded from the study when it became logistically impossible to inform these patients about the study and introduce the decision support tools.

The primary outcome measure was the level of shared decision-making during the consultation according to the OPTION-5 (5-item observing patient involvement) instrument.

A total of 342 patients (40% women) were included, of whom 44.2% were in the control group and 55.8% were in the intervention group. The mean age of study participants was 62 years (standard deviation [SD], 13.3) in the control group and 65 years (SD, 12.9) in the intervention group. Among the participants, 87 had an abdominal aortic aneurysm, 143 had intermittent claudication, and 112 had varicose veins.

Following implementation of the decision support tools, the overall mean OPTION-5 score was significantly increased (37.8% [SD, 12.4] vs 28.7% [SD, 12.4]; mean difference, 9.1% [95% CI, 6.5-11.8; P <.001]). OPTION-5 scores were increased across all 3 disease groups, with the increase being significant (P < .001) for patients with intermittent claudication and varicose veins.

The decision-support tool intervention, consultation duration, type of disease, and type of hospital were significant independent factors that affected the OPTION-5 score.

The median Shared Decision Making Questionnaire-physician version (SDM-Q-Doc) score for clinicians was significantly higher in the intervention group (80.0%; interquartile range [IQR] 71.1-86.7, 4.5% top score) vs the control group (73.3%, IQR 64.4-84.4, 2.8% top score).

Patient knowledge scores were significantly higher after introduction of the decision support tools (median difference: 13.3%; effect size: 0.13; P =.025).

Patients with abdominal aortic aneurysm and intermittent claudication more frequently preferred nonsurgical treatment options when decision support tools were used. Following the intervention, the percentage of patients with abdominal aortic aneurysm who chose conservative treatment significantly increased from 7.4% to 28.8% (95% CI, 23.2-35.9). Among patients with intermittent claudication, preference for percutaneous transluminal angioplasty treatment significantly decreased from 70% to 47% (difference: -24%, 95% CI, -38.3 to -7.2). Preference for continued supervised exercise training and conservative treatment increased significantly from 16% to 32% and nonsignificantly from 8% to 17%, respectively.

Shared decision-making training for clinicians (P <.001) and the decision aid for patients (P =.047) were found to most effectively enhance shared decision-making.

Among several study limitations, differences in severity and patient characteristics among the disease types could have affected the overall OPTION-5 scores. Also, not all of the intervention tools were used by every hospital or by individual clinicians. Furthermore, clinicians were likely aware of the study design, which could have affected their behavior and SDM-Q-Doc scores before implementation of the decision support tools.

“This multicenter stepped-wedge trial shows that the application of [decision support tools] in vascular surgery promotes patient involvement in the decision-making process for their vascular disease,” stated the researchers. “Patients were more knowledgeable about their disease and treatment options and less often chose invasive treatment options, without any adverse effects in terms of a higher decisional conflict or reduced quality of life.”

Reference

Stubenrouch FE, Peters LJ, de Mik SML, et al; on behalf of the OVIDIUS study group. Improving shared decision-making in vascular surgery: a stepped-wedge cluster-randomised trial.Eur J Vasc Endovasc Surg. Published online April 25, 2022. doi:10.1016/j.ejvs.2022.04.016