DEVELOPMENT OF A PATIENT DECISION AID FOR PATIENTS WHO ARE HIGH RISK CANDIDATES FOR CORONARY ARTERY BYPASS SURGERY

Abstract

Coronary artery bypass grafting (CABG) carries a risk of morbidity and mortality. These risks are significantly increased in patients with certain pre-existing co-morbidities. Alternative treatments such as PCI or medical management may be considered in these high-risk patients. In Canada, there is no clear framework to support patients' decision-making when faced with such treatment options. A Patient Decision Aid (PtDA) provides structured and evidence-informed decision support, has been shown to decrease decisional conflict or treatment uncertainty, and can meet health-goals that are consistent with the patient’s values. This study focuses on the development and evaluation of a PtDA for higher risk patients considered ineligible for PCI, comparing the option of CABG versus optimal medical management. The development process was guided by the Ottawa Decision Support Framework (ODSF) and the International Patient Decision Aid Standards (IPDAS). The development panel was comprised of health-service researchers, decision science experts, interventional cardiologists, cardiovascular surgeons and intensivists. The first step was to draft the PtDA, which required synthesizing outcome evidence from CABG trials, systematic reviews and meta-analyses. Input from physician experts on local data informed probabilities of risks and benefits to populate the PtDA. The preliminary PtDA data compiled is presented in Figure 1a and 1b. A Needs Assessment survey, currently underway, will help streamline content of the PtDA based on what outcomes patients’ value most, and thus inform value-based clinical decision-making. A patient advisory committee (n=3) will review and evaluate the next draft of the PtDA after incorporation of the findings from the Needs Assessment. Modifications based on patient and family input will be made, if necessary. Finally, the PtDA will be uploaded to the Ottawa Decision Aid Library Inventory for external review. The implementation will be supported and endorsed by the hospital administration as part of their quality improvement initiative to provide integrated, effective and patient-centred care. The aim of this project is to develop a PtDA for patients being considered for CABG, as consistent with the ODSF and IPDAS. This PtDA aims to moderate treatment-related uncertainty, inform patient-centred outcomes and prepare patients to make well-informed decisions. However, additional research is required to improve consensus in defining high-risk patients, and identifying outcomes important to this select group of high-risk patients when faced with a decision of CABG versus optimal medical therapy. Overall, the decision support provided by the PtDA will enhance the decision-making process between patients, physicians, and families.View Large Image Figure ViewerDownload Hi-res image Download (PPT)