Testing of a risk-stratified patient decision aid to facilitate shared decision-making for extended postoperative thromboprophylaxis after major abdominal surgery for cancer.

IF 2.2 4区 医学 Q2 SURGERY Canadian Journal of Surgery Pub Date : 2024-08-27 Print Date: 2024-07-01 DOI:10.1503/cjs.014722
Victoria Ivankovic, Megan Delisle, Dawn Stacey, Jad Abou-Khalil, Fady Balaa, Kimberly A Bertens, Brittany Dingley, Guillaume Martel, Kristen McAlpine, Carolyn Nessim, Shaheer Tadros, Marc Carrier, Rebecca C Auer
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Abstract

Background: Use of extended pharmacologic thromboprophylaxis after major abdominopelvic cancer surgery should depend on best-available scientific evidence and patients' informed preferences. We developed a risk-stratified patient decision aid to facilitate shared decision-making and sought to evaluate its effect on decision-making quality regarding use of extended thromboprophylaxis.

Methods: We enrolled patients undergoing major abdominopelvic cancer surgery at an academic tertiary care centre in this pre-post study. We evaluated change in decisional conflict, readiness to decide, decision-making confidence, and change in patient knowledge. Participants were provided the appropriate risk-stratified decision aid (according to their Caprini score) in either the preoperative or postoperative setting. A sample size calculation determined that we required 17 patients to demonstrate whether the decision aid meaningfully reduced decisional conflict. We used the Wilcoxon matched-pairs signed ranks test for interval scaled measures.

Results: We included 17 participants. The decision aid significantly reduced decisional conflict (median decisional conflict score 2.37 [range 1.00-3.81] v. 1.3 [range 1.00-3.25], p < 0.01). With the decision aid, participants had high confidence (median 86.4 [range 15.91-100]) and felt highly prepared to make a decision (median 90 [range 55-100]). Median knowledge scores increased from 50% (range 0%-100%) to 75% (range 25%-100%).

Conclusion: Our risk-stratified, evidence-based decision aid on extended thromboprophylaxis after major abdominopelvic surgery significantly improved decision-making quality. Further research is needed to evaluate the usability and feasibility of this decision aid in the perioperative setting.

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测试风险分级患者决策辅助工具,以促进癌症腹部大手术后延长术后血栓预防的共同决策。
背景:腹盆腔肿瘤大手术后延长血栓预防药物的使用应取决于现有的最佳科学证据和患者的知情偏好。我们开发了一种风险分层患者决策辅助工具,以促进共同决策,并试图评估其对延长血栓预防药物使用期的决策质量的影响:方法:我们招募了在一家学术性三级医疗中心接受腹盆腔肿瘤大手术的患者参与这项前后对比研究。我们评估了决策冲突的变化、决策的准备程度、决策的信心以及患者知识的变化。我们在术前或术后为参与者提供了适当的风险分级辅助决策工具(根据他们的卡普里尼评分)。通过样本量计算,我们确定需要 17 名患者才能证明决策辅助工具是否能有效减少决策冲突。我们使用Wilcoxon配对符号秩检验进行区间标度测量:结果:我们纳入了 17 名参与者。决策辅助工具明显减少了决策冲突(决策冲突得分中位数为 2.37 [范围 1.00-3.81] 对 1.3 [范围 1.00-3.25], p < 0.01)。使用决策辅助工具后,参与者信心十足(中位数 86.4 [范围 15.91-100]),并认为自己为做出决策做好了充分准备(中位数 90 [范围 55-100])。知识得分中位数从 50%(范围 0%-100%)提高到 75%(范围 25%-100%):我们关于腹盆腔大手术后延长血栓预防的风险分级循证决策辅助工具显著提高了决策质量。还需要进一步研究,以评估该决策辅助工具在围手术期环境中的可用性和可行性。
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来源期刊
CiteScore
3.00
自引率
8.00%
发文量
120
审稿时长
6-12 weeks
期刊介绍: The mission of CJS is to contribute to the meaningful continuing medical education of Canadian surgical specialists, and to provide surgeons with an effective vehicle for the dissemination of observations in the areas of clinical and basic science research.
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