Decision aids during surgical consultation effective in aligning patient preferences when choosing between open repair and endovascular repair for abdominal aortic aneurysms

1. In this cluster randomized trial that included 235 patients with abdominal aortic aneurysms, those who were counselled on both open and endovascular repair types using a decision aid were significantly more likely to receive the repair type they preferred compared to the control group.

2. A majority of patients preferred endovascular aortic aneurysm repair over open repair in both the decision aid group (79% of patients) and control group (76% of patients).

Evidence Rating Level: 1 (Excellent)

Study Rundown: Surgical interventions for abdominal aortic aneurysm (AAA) include open repair and endovascular repair. While endovascular aortic aneurysm repair (EVAR) is less invasive and associated with reduced perioperative mortality, it requires lifelong surveillance and has a risk of late aneurysm-related death when compared with open repair. These factors can make it difficult for patients to decide which AAA repair type is best suited for them. As such, the objective of this study was to determine the effect of a decision aid on agreement between patient preference for AAA repair type and the repair type they ultimately receive. A total of 235 patients were enrolled and randomized to receive either a presurgical consultation using a decision aid (n=126), or usual care (n=109). The main outcome was the proportion of patients who had agreement between their preference and their repair type. Patients preferred EVAR over open repair in both the decision aid group and the control group. Moreover, patients in the decision aid group were more likely to receive their preferred repair type when compared to controls receiving usual care. This suggests that decision aids are suitable to help better align patients with their treatment preferences for major cardiovascular procedures. A limitation to this study is that the cohort was restricted to US veterans, and as such, the results may not be generalizable on a broader scale.

Click to read the study in JAMA Surgery

Click to read an accompanying editorial in JAMA Surgery

Relevant Reading: Patient information sources when facing repair of abdominal aortic aneurysm

In-Depth [randomized controlled trial]: In this study, a total of 235 patients [234 (99.6% male), mean (SD) age 73 (5.9)] were enrolled across 22 sites between June 2017 and February 2020, of which 126 patients were enrolled in the 11 decision aid sites, and 109 patients were enrolled in the 11 control sites. The comorbidities of participants included hypertension (89 of 126 [87%] in the decision aid group vs 76 of 109 [87%] in the control group, diabetes (39 [31%] in the decision aid group vs 38 [35%] in the control group), and chronic kidney disease (34 [27%] in the decision aid group vs 23 [31%] in the control group. Aneurysm characteristics were similar amongst both groups, with a mean (SD) aneurysm diameter of 5.7 (0.6) cm (P = .45). Patients preferred EVAR over open repair in both the decision aid group (96 of 122 [79%]) and the control group (81 of 106 [76%]), P = .60. Patients in the decision aid group were more likely to receive their preferred AAA repair type compared to patients receiving usual care (95% agreement [93 of 98] vs 86% agreement [81 of 94]; P = .03). Additionally, k statistics were higher in the decision aid group (k = 0.78; 95% CI, 0.60-0.95) compared with the control group (k = 0.53; 95% CI, 0.32-0.74). Adjustment models were used to confirm this association (odds ratio of agreement in the decision aid group relative to the control group, 2.93; 95% CI, 1.10-7.70).

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