Shared Decision-Making in Vascular Surgery: A Mixed-Methods Systematic Review

This study aimed to evaluate the current state of shared decision-making (SDM) in vascular surgery with a focus on abdominal aortic aneurysm (AAA), peripheral arterial disease (PAD), and carotid disease by synthesizing both qualitative and quantitative evidences.

We conducted a mixed-methods systematic review following PRISMA guidelines. MEDLINE, Embase, CENTRAL, Web of Science, and Epistemonikos were searched through October 2025. Primary quantitative, qualitative, and mixed-methods studies involving adult patients with AAA, PAD, or carotid artery disease were included. Risk of bias was assessed using the Mixed Methods Appraisal Tool. Due to heterogeneity, results were synthesized narratively without meta-analysis.

Fifty-two studies were included, comprising 26 quantitative, 19 qualitative, and 7 mixed-methods studies. Twenty-four studies evaluated SDM in AAA, 14 in PAD, 5 in carotid artery disease, and 9 included mixed vascular cohorts. In AAA, observer-rated SDM improved after SDM interventions, with OPTION-5 scores increasing from 28.7% to 37.8% (P-value <0.001). Patient knowledge improved; however, patient-reported SDM, decisional conflict, satisfaction, and quality of life measures showed no significant change. In PAD, observer-rated SDM remained low (mean OPTION-5 score of 31.0%), despite high patient-reported SDM (SDM-Q-9 score of 93.0%). SDM interventions improved patient knowledge, particularly in intermittent claudication, while decisional outcomes remained unchanged. In carotid artery disease, although 93.0% of patients preferred SDM, only 54.0% reported being offered treatment choices.

In vascular surgery, despite a strong preference among patients to be actively involved in decisions regarding their care, SDM remains inconsistently implemented in clinical practice. Further SDM interventions should be implemented to address this discrepancy and to improve patient care.