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Improving Shared Decision Making in Vascular Surgery: A Stepped Wedge Cluster Randomised Trial.

Fabienne E Stubenrouch¹, Loes J Peters², Sylvana M L de Mik³

¹Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Department of Radiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.

European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery

|April 28, 2022

Summary

Implementing decision support tools (DSTs) in vascular surgery significantly enhances shared decision making (SDM) and patient knowledge. This leads to a greater preference for non-surgical treatments, improving patient care and outcomes.

Keywords:

Decision support tools OPTION-5 instrument Shared decision-making Vascular surgery

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Area of Science:

Vascular Surgery
Health Services Research

Background:

Shared decision making (SDM) is crucial in vascular surgery but currently underutilized in outpatient settings.
Decision support tools (DSTs) have been developed to improve SDM, including patient decision aids and consultation cards.

Purpose of the Study:

To evaluate the effectiveness of DSTs and SDM training in improving shared decision making in vascular surgery.
To assess the impact of these interventions on patient knowledge and treatment choices.

Main Methods:

A stepped wedge cluster randomized trial was conducted in 13 Dutch hospitals.
Interventions included DSTs and SDM training for clinicians.
Data were collected via questionnaires and audio recordings, with the OPTION-5 score as the primary outcome.

Main Results:

The mean OPTION-5 score significantly improved from 28.7% to 37.8% after DST implementation.
Patient knowledge increased significantly, and the proportion of patients opting for non-surgical treatments rose.
SDM training for surgeons and decision aids for patients independently boosted OPTION-5 scores.

Conclusions:

DSTs effectively improve SDM levels in vascular surgery, enhance patient knowledge, and encourage non-surgical treatment preferences.
SDM training for clinicians and decision aids for patients were the most impactful interventions for enhancing SDM.