Exploring Patient Involvement in Decision-Making for Vascular Procedures
Jennifer A. Avise1, Laura A. Peterson1, Jeanette M Stafford1, Derrick S Boone, Sr.2, Douglas Easterling1, Gregory L Burke1, Matthew A. Corriere1
1Wake Forest University School of Medicine, Winston Salem, NC;2Wake Forest University School of Business, Winston Salem, NC
Introduction: Initiatives to develop patient-centered approaches to healthcare is a priority that may have profound effects on healthcare, particularly within value-based purchasing and risk -sharing models. Patient-centered care requires more direct engagement of patients in their own care, including treatment decisions. Patient participation in treatment selection for vascular procedures has not been characterized and the potential effects of greater patient involvement are unknown. We conducted a prospective study among patients undergoing vascular procedures to identify important sources of information and characterize experienced versus desired decision-making roles.
Methods: Patients undergoing elective vascular procedures were identified from an outpatient clinic and vascular laboratory. An instrument consisting of multiple choice and open-ended response items related to patients’ roles in decision-making, sources of information, and perceived treatment success was administered. Diagnostic, demographic, and educational data were collected. Descriptive statistics are presented as count (%) for categorical variables or mean ± standard deviation for continuous variables. Categorical responses are presented as median [interquartile range] based on a 1-5 ordinal scale.
Results: 74 patients undergoing intervention for abdominal aortic aneurysm (AAA) (N=20), hemodialysis access (N=14), carotid stenosis (N=20), and peripheral arterial disease (N=20) participated. Mean age was 68.8±12.4 years, 43% were women, and 26% were African American. Highest educational level was college or graduate school for 35% of participants; 61% had computer access, and 41% regularly used e-mail. Participants identified providers as the most important information sources (1[1,1] for doctors and 2[1,3] for nurse practitioners where 1=”very important” and 5=”not important”), while family and friends, written materials, and other patients were less important (3[1,5], 3[2,4], and 3[2,5], respectively), and television/video and internet resources were least important (4.5[3,5] and 5[3,5], respectively). Although participants had high levels of confidence in provider recommendations (1[1,1] for all procedure categories where 1=”very satisfied” and 5=”not satisfied”), they had a strong preference to discuss all potential treatment options (1[,1,1] where 1=”strongly agree” and 5=”strongly disagree”) and to choose their treatment together with their doctor (1[1,2]) as opposed to only discussing the recommended treatment (2[1,3]) or delegating selection to the doctor alone (2[1,3]). Patients undergoing hemodialysis access and AAA procedures most often reported discussion of more than one option (1.5[1,3] and 1.5[1,5], respectively), while discussion of multiple options was less common for peripheral arterial disease (2[1,3.5]) and carotid stenosis (3[1,5]). 37 participants (50%) considered their first treatment successful, 27 (36.5%) considered another subsequent treatment successful, and 10 (13.5%) considered none successful.
Conclusion: Patients experience varying participation levels in decision-making for vascular procedures and often believe that their treatments are unsuccessful. Although patients consider providers an important source of information and have confidence in their recommendations, they prefer to discuss all treatment options being considered. Patients also prefer shared decision-making over complete delegation to the provider. Increasing patient involvement in treatment decisions has potential to improve patient satisfaction but may require tools to facilitate more active participation;potential impacts on other outcomes remains to be determined.
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