Shared decision-making in patients with abdominal aortic aneurysm and peripheral arterial disease: a qualitative...

The aim of this study was to gain insight in how patients with an abdominal aortic aneurysm (AAA) or peripheral arterial disease (PAD) experience shared decision-making (SDM) and to examine the role of health literacy (HL), specifically the domain of knowledge and information provision.

An original qualitative descriptive study was conducted using the principles of reflexive thematic analysis. Semi-structured interviews were conducted with purposively sampled vascular surgery patients from the University Medical Center Groningen and Ommelander Hospital Groningen between March and September 2024. Data collection and analysis followed an iterative approach, with interviews audio-recorded, transcribed, and analyzed inductively. Health literacy (Brief Health Literacy Screener), frailty (Groningen Frailty Indicator), and cognition (Mini-Cog) were assessed to contextualize findings. Data saturation was reached when no new insights emerged. Descriptive statistics were used for quantitative measures.

Data saturation was reached after conducting 11 interviews. Four themes emerged regarding SDM and HL disease knowledge and information provision: 1) the decision; 2) desires, goals, and concerns; 3) information; and 4) disease knowledge. While some patients perceived active participation, most felt minimally involved, partly because their goals and concerns were not actively addressed by the treating physician. Patients generally regarded the vascular surgeon as their primary source of information. Knowledge levels and information needs varied between the included patients, influencing patient engagement in SDM.

In this qualitative study, patients with AAA or PAD generally felt minimally involved in decision-making and often assumed that their vascular surgeon was unaware of their personal goals. Disease knowledge was typically limited, likely hindering patient participation in SDM.