Development of a Multidisciplinary Decision Support Instrument for Patients With a Ruptured Abdominal Aortic Aneurysm...

Area of Science:

• Medical Decision Making
• Vascular Surgery
• Geriatrics

Background:

• Treatment decisions for ruptured abdominal aortic aneurysms (rAAA) are complex, time-sensitive, and often made with incomplete information.
• Multidisciplinary consultation is frequently unavailable in emergency scenarios.

Purpose of the Study:

• To develop a decision-support instrument (DSI) that predicts expert decisions for rAAA treatment.
• To incorporate patient-specific factors like frailty, life expectancy, and treatment preferences into the DSI.

Main Methods:

• A discrete choice experiment was used to develop the DSI.
• A multidisciplinary expert panel defined criteria and evaluated fictional patient scenarios.
• Relative importance (RI) weights were assigned to each criterion based on expert consensus.

Main Results:

• Eleven criteria were identified as influencing rAAA treatment decisions.
• The most significant criteria were cardiac burden (15% RI), age (13% RI), life expectancy (13% RI), Clinical Frailty Scale (12% RI), and pulmonary burden (12% RI).
• The DSI predicts the percentage of specialists who would opt for surgery based on patient criteria.

Conclusions:

• A clinical DSI was developed using multidisciplinary expert consensus for acute rAAA treatment planning.
• Patient frailty, estimated life expectancy, and patient's desire for operation were identified as crucial, often underreported, decision factors.
• The DSI can support consistent decision-making in complex, urgent rAAA cases and aid in identifying patients suitable for palliative care.