Key result
Shared decision-making yields a ~27% refusal rate for elective aortic aneurysm surgery, linked to smaller aneurysms.
Why the study?
Vascular surgery patients desire more active participation and full knowledge of therapeutic options, but often find it difficult to express themselves and choose appropriately.
Does shared decision making influence the refusal rate of elective surgery in asymptomatic patients with aortic aneurysms?
Observational (n=49)
No
Does shared decision making influence the refusal rate of elective surgery in asymptomatic patients with aortic aneurysms?
Absolute Event Rate: 9% vs 26%
p-value: p=0.003
Implementing shared decision making with detailed informed consent led to a 26.5% refusal rate for elective aortic aneurysm surgery, primarily among patients with smaller aneurysms.
May increase refusals for smaller aneurysms after shared decision making; hypothesis-generating and requires randomized trials before practice change.
Introduction Studies show that vascular surgery patients have the desire to participate more actively in their treatment, but that they find it difficult to express themselves. Patients prefer to know all the therapeutic options available, not just those that the surgeon considers appropriate. With this knowledge, patients can begin to choose the most appropriate therapeutic modality for themselves, also becoming responsible for the therapeutic decision. Therefore, the objective of this paper was to analyze the refusal rate of elective aortic aneurysm surgery in asymptomatic patients after the presentation of a detailed IC form followed by a meeting where the patient and his or her family could analyze each item; Methods Data from 49 patients who had aneurysms and were offered surgical treatment were retrospectively collected and analyzed. Results After reading the IC and the described meeting, among the 49 patients, 13 (26.5%) refused surgery. We observed that patients who refused surgery had statistically smaller aneurysms than patients who accepted surgery (9% versus 26%). Conclusion One-quarter of patients who were indicated for elective surgical correction of aortic aneurysms rejected surgery after SDM, which consisted of the presentation of an IC form followed by a clarification meeting for the patient and his or her family to analyze each item. The only factor that significantly influenced a rejection of the procedure was the size of the aneurysm, so patients who rejected surgery had smaller aneurysms than those who accepted surgery.
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Cunha et al. (2021) conducted an observational in Asymptomatic aorto-iliac aneurysms (n=49). Refusal of elective aortic aneurysm surgery vs. Acceptance of surgery was evaluated on Aneurysm size percentage above the surgical threshold (PaT) (p=0.003). After shared decision-making, 26.5% of patients refused elective aortic aneurysm surgery; refusal was significantly associated with smaller aneurysm size (9% vs 26% above surgical threshold, p=0.003).
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