Department of Surgery and VA Outcomes Group, White River Junction VA Medical Center, White River Junction, Vt; Geisel School of Medicine at Dartmouth, Hanover, NH.
Department of Surgery and VA Outcomes Group, White River Junction VA Medical Center, White River Junction, Vt.
J Vasc Surg. 2020 Feb;71(2):497-504. doi: 10.1016/j.jvs.2019.04.460. Epub 2019 Jul 26.
Shared medical decision making is most important when there are competing options for repair such as in treatment of abdominal aortic aneurysm (AAA). We sought to understand the sources of patients' pre-existing knowledge about AAA to better inform treating physicians about patients' needs for preoperative counseling.
We performed a multicenter survey of patients facing AAA repair at 20 Veterans Affairs hospitals across the United States as part of the Preferences for Open Versus Endovascular Repair of AAA study. A validated survey instrument was administered to examine the sources of information available and commonly used by patients to learn about their repair options. The survey was administered by study personnel before the patient had any interaction with the vascular surgeon because survey data were collected before the vascular clinic visit.
Preliminary analysis of data from 99 patients showed that our cohort was primarily male (99%) and elderly (mean age 73 years). Patients commonly had a history of hypertension (86%), prior myocardial infarction (32%), diabetes (32%), and were overweight (58%). Patients arrived at their surgeon's office appointment with limited information. A majority of patients (52%) reported that they had not talked to their primary care physician at all about their options for AAA repair, and one-half (50%) reported that their view of the different surgical options had not been influenced by anyone. Slightly less than one-half of patients reported that they did not receive any information about open surgical aneurysm repair and endovascular aortic aneurysm repair (41% and 37%, respectively). Few patients indicated using the internet as their main source of information about open surgical aneurysm repair and endovascular aortic aneurysm repair (10% and 11%, respectively).
Patients are commonly referred for AAA repair having little to no information regarding AAA pathology or repair options. Fewer than one in five patients searched the internet or had accessed other sources of information on their own. Most vascular surgeons should assume that patients will present to their first vascular surgery appointment with minimal understanding of the treatment options available to them.
当存在相互竞争的修复方案时，例如在治疗腹主动脉瘤（AAA）时，共享医疗决策最为重要。我们试图了解患者对 AAA 的预先存在的知识来源，以便更好地告知治疗医生患者对术前咨询的需求。
我们在美国 20 家退伍军人事务医院进行了一项多中心调查，调查对象为面临 AAA 修复的患者，该调查是“AAA 开放修复与血管内修复偏好研究”的一部分。我们采用了经过验证的调查工具来检查患者获取其修复方案的信息来源和常用信息来源。在患者与血管外科医生进行任何交流之前，由研究人员对患者进行调查，因为调查数据是在血管科就诊之前收集的。
对 99 例患者数据的初步分析表明，我们的研究对象主要为男性（99%）和老年人（平均年龄 73 岁）。患者普遍有高血压病史（86%）、既往心肌梗死（32%）、糖尿病（32%）和超重（58%）。患者就诊时仅掌握有限的信息。大多数患者（52%）报告说他们根本没有与初级保健医生谈论过 AAA 修复的选择，并且有一半（50%）的患者表示，他们对不同手术方案的看法没有受到任何人的影响。略少于一半的患者报告说他们没有收到任何关于开放手术动脉瘤修复和血管内主动脉瘤修复的信息（分别为 41%和 37%）。很少有患者表示他们没有将互联网作为获取开放手术动脉瘤修复和血管内主动脉瘤修复的主要信息来源（分别为 10%和 11%）。
患者通常被转诊进行 AAA 修复，但对 AAA 病理或修复方案几乎没有了解。不到五分之一的患者会上网搜索或自行获取其他信息来源。大多数血管外科医生应假定患者在首次就诊时对可提供的治疗方案仅有很少或几乎没有了解。
