DO SURGEONS FOSTER SHARED DECISION MAKING IN THEIR COMMUNICATION WITH PATIENTS ABOUT THEIR ABDOMINAL AORTIC ANEURYSM?

Purpose: To determine to what extent surgeons communicate essential information to patients with an abdominal aortic aneurysm, in order to make an informed choice or to give informed consent regarding surgery or watchful waiting.

Method: Dutch vascular surgeons were invited to sound-record their consultations with aneurysm patients. Recordings were scored using a checklist with categories based on European law and aspects of informed decision making: (1) the disorder, (2) procedure and aim of surgery, (3) consequences and risks of surgery, (4) watchful observation, (5) individual prognosis regarding the patient’s state of health, and (6) patient involvement in the decision. Each category was represented by several information items, which were scored dichotomously (“not mentioned” or “mentioned”). A category was considered sufficiently addressed if at least one of its items was mentioned.

Result: Thirty-five consultations were recorded by 11 vascular surgeons. They took a median of seven minutes (IQR 5-17). Mean aneurysm diameter was 5.7 cm (SD 1.2). Significant morbidity was present in 23 patients (66%), which increased their operative risk. In only a minority of recordings, all five categories were addressed: 10/35 (29%). None of the information items was discussed consistently in every recording. Although most patients were informed about the proposed treatment option (30/35; 86%), the alternative treatment option was mentioned only occasionally (18/35; 51%). Surgeons rarely stated that the patient has a role in decision making (10/35; 29%) and patients’ preferences were elicited in only less than one quarter of the consultations (8/35; 23%).

Conclusion: Patients with an abdominal aneurysm are informed inconsistently about their disorder and treatment options. Information is often less than legally required. This may hinder shared decision making.