Abstract WMP102: Development and Testing of a Web-Based Decision Aid to Improve Decision Making for Asymptomatic Carotid Disease

Abstract

Introduction: Patients (Pts) with asymptomatic (ASX) carotid stenosis have 3 treatment (Rx) options (surgery[CEA], stenting[CAS], and medical therapy alone[Med],) each with its own risks and benefits (R/Bs). In prior work, many ASX Pts who had CEA did not understand the disease (Dz), their Rx options, and associated R/Bs. Decision aids (DAs) have been shown in other conditions to foster more informed Rx choices. Objective: To develop and assess the impact of a DA on knowledge of Dz, Rx options, and DA satisfaction. Methods: We created a multimedia, web-based DA to explain ASX carotid Dz, Rx options, and associated R/Bs. The DA was refined and vetted by experts in neurology, vascular/neuro-surgery, internal medicine, decision making, and patient education. The DA included: text, anatomic graphics, pictographs of short term and long R/Bs of CEA v. Med, and Pt and MD video testimonials. We tested it in an online Pt panel in those: 55+ yrs with ≥ 1 risk factor for carotid Dz (HTN, DM, CHOL, CAD, PVD). Post-viewing knowledge of key educational messages incl. Rx options, associated R/Bs, and DA satisfaction were assessed with validated instruments. Results: Overall, 1778 of 1843 completed viewing the 40 minute DA (96%). Mean age was 67 yrs, 51% female, 91% White, and 24% ≤high school degree. Pts correctly answered 68% of the 19 knowledge items. The DA was well-liked with mean score of 4.4 (out of 5) on a 10 item DA satisfaction score and 4.3 (out of 5) on a 7 item DA helpfulness score. Pts correctly grasped most gist messages including that: not everyone needed CEA (99%), there was no best Rx it depends on the Pt (92%), they had time to make a decision (86%), CEA can cause stroke (92%), CEA can cause death (91%), and carotid Dz can cause stroke (83%). They had trouble understanding the time trade of CEA v. Med-only 55% correctly said CEA was riskier in the short term, and 50% that Med was riskier in the long term. Overall, 74% said they would choose Med. Pts who were younger, female, White, higher education, or with family/friends with stroke or CAD had higher knowledge scores. Conclusions: A web-based DA was effective in conveying most gist messages regarding making an informed decision in ASX carotid Dz. The next step is testing the impact of the DA in Pts facing a real decision about revascularization.