Abstract 16: Preferences for Shared Decision Making in International Patients With Peripheral Arterial Disease: Insights From the PORTRAIT Study

Abstract

Background: There is no ‘gold-standard’ treatment for Rutherford Grade I (mild-severe claudication) peripheral arterial disease (PAD), with different treatments associated with different benefits and risks. The choice of treatment should therefore be sensitive to patients’ preferences and supported by shared-decision making. It is, however, unknown to what degree patients seeking treatment for claudication symptoms want to be involved in the medical decision process for their PAD treatment. Method: The international PORTRAIT study enrolled 1142 patients with new or an exacerbation of claudication symptoms between June 2, 2011 and September 25, 2015 from 17 PAD specialty clinics. Upon PAD evaluation, patients were interviewed to assess preferences for shared decision making using the Preferences for Shared Decision Making Scale. Information on demographic, socio-economic, and clinical factors were obtained from medical records and interviews. A multivariable log-binomial regression model examined patient- and site-level characteristics associated with an autonomous or shared vs. a passive decision-making role when selecting PAD treatment. Results: Among 1142 patients, 56% (n=638) preferred shared or autonomous decision-making, whereas 44% (n=504) preferred that the doctor alone (passive role) made the decision for their PAD treatment. Whether or not patients preferred a shared/autonomous decision-making role varied greatly across countries (The Netherlands 33%; Australia, 43%; US, 70%; P<0.0001). Other independent predictors of shared/autonomous decision making were having completed high school education or more (P=0.001) (Figure 1). Conclusion: While the majority of patients prefer an active role in the medical decision process for their PAD treatment, preferences differed markedly by geographic region and education level. US Patients and more educated patients preferred a shared/autonomous decision-making role. Given the observed variability, it is important that providers elicit patients’ wishes regarding their desired involvement in PAD treatment decision-making and tailor their processes to meet patients’ preferences. Future work should also focus on developing care innovations that can increase patient engagement in care.