From the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Ivankovic, Delisle, Balaa, Dingley); the School of Nursing, University of Ottawa, Ottawa, Ont. (Stacey); the Ottawa Hospital Research Institute, Ottawa, Ont. (Stacey, Abou-Khalil, Bertens, Martel, Nessim, Tadros, Carrier, Auer); the Department of Surgery, University of Ottawa, Ottawa, Ont. (Abou-Khalil, Bertens, Martel, Nessim, Tadros, Auer); the Division of Urology, Department of Surgery, University of Toronto, Toronto, Ont. (McAlpine); and the Department of Medicine, University of Ottawa, Ottawa, Ont. (Carrier).
From the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Ivankovic, Delisle, Balaa, Dingley); the School of Nursing, University of Ottawa, Ottawa, Ont. (Stacey); the Ottawa Hospital Research Institute, Ottawa, Ont. (Stacey, Abou-Khalil, Bertens, Martel, Nessim, Tadros, Carrier, Auer); the Department of Surgery, University of Ottawa, Ottawa, Ont. (Abou-Khalil, Bertens, Martel, Nessim, Tadros, Auer); the Division of Urology, Department of Surgery, University of Toronto, Toronto, Ont. (McAlpine); and the Department of Medicine, University of Ottawa, Ottawa, Ont. (Carrier)
Can J Surg. 2024 Aug 27;67(4):E320-E328. doi: 10.1503/cjs.014722. Print 2024 Jul-Aug.
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.
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.
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], < 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%).
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.
在接受大腹部和骨盆癌症手术后，使用延长的药物性血栓预防措施应取决于最佳的科学证据和患者的知情偏好。我们开发了一种风险分层的患者决策辅助工具，以促进共同决策，并试图评估其对使用延长的血栓预防措施的决策质量的影响。
我们在一个学术性的三级保健中心进行了这项前瞻性研究，招募了接受大腹部和骨盆癌症手术的患者。我们评估了决策冲突、决策准备程度、决策信心和患者知识变化。根据他们的卡普里尼评分，参与者在术前或术后获得适当的风险分层决策辅助工具。样本量计算确定我们需要 17 名患者来证明决策辅助工具是否有意义地降低决策冲突。我们使用 Wilcoxon 配对符号秩检验进行区间尺度测量。
我们纳入了 17 名参与者。决策辅助工具显著降低了决策冲突（中位数决策冲突得分 2.37 [范围 1.00-3.81] v. 1.3 [范围 1.00-3.25]，<0.01）。有了决策辅助工具，参与者具有高度的信心（中位数 86.4 [范围 15.91-100]），并感到高度准备做出决策（中位数 90 [范围 55-100]）。知识得分中位数从 50%（范围 0%-100%）增加到 75%（范围 25%-100%）。
我们的大腹部和骨盆手术后延长血栓预防措施的风险分层、基于证据的决策辅助工具显著提高了决策质量。需要进一步研究评估这种决策辅助工具在围手术期的可用性和可行性。
