Study Protocol for a Focus Group Discussion About the Patients' Perspective on Carotid Endarterectomy.

Introduction: The outcomes of carotid surgery are commonly evaluated using parameters such as mortality and stroke. The importance of these parameters is based on doctors' and scientific perspectives. Presently, patient centered health care aims to value the evaluation from patients' perspective, mostly using Patient-Reported Outcomes (PROs). The true significance of outcomes of carotid surgery that matter most to the patients is largely unknown. The aim of this study is to identify and verify the patients' perspective on carotid surgery for patients with a symptomatic and significant carotid stenosis.

Methods and outcomes: An exploratory semi-structured focus group discussion will be used, as a quality research method. Three groups consisting of 8 patients (n = 24), who underwent the carotid endarterectomy because of a significant and symptomatic stenosis of the internal carotid artery, will be enrolled. If data saturation is not reached, the sample size will be expanded. An expert medical psychologist will lead the focus group discussions. The interviews will be recorded, transcribed 'verbatim' and analyzed after each session. Items valuable to patients regarding their surgery and recovery will be discussed. This protocol will be published prior to the start of the Focus Group Discussion.

Discussion: Patients' perspective on outcomes regarding their carotid surgery will be explored and tried to be identified. The results of the focus group discussions may fuel the ongoing global discussion on improving evidence based and patient reported outcome measures and will help the clinical physician to 'understand' their patients better. Focus group discussions may aid in the purpose of verification of PROs and PROMs.