Abstract
ObjectiveTo investigate the association between patients' preferred treatment and eventual treatment. Second, to compare patients with surgical treatment to watchful waiting in order to identify predictive factors for surgery.MethodsA single‐centre retrospective study was performed between December 2015 and August 2018. Patients (≥18 years) who used a patient decision aid (PDA) for gallstones or inguinal hernia were included. After their first surgical consultation, patients received access to an online PDA. The patients' preferred treatment after the PDA was compared with their choice of eventual treatment. Multivariable regression analyses were performed for predictive factors for surgery.ResultsIn total, 567 patients with gallstones and 585 patients with an inguinal hernia were included. Of the patients with gallstones, 121 (21%) preferred watchful waiting, 367 (65%) preferred surgery, and 79 (14%) were not sure. The patients' preferred treatment was performed in 85.9%. Frequent pain attacks (OR 2.1, 95% CI 1.1‐3.9, P = .020) and preference for surgery (OR 4.4, 95% CI 1.9‐10.1, P = .001) independently predicted surgery. Of the patients with an inguinal hernia, 77 (13.2%) preferred watchful waiting, 452 (78.8%) preferred surgery, and 56 (9.6%) were not sure. The patients' preferred treatment was performed in 86.0%. The preference for surgery (OR 5.2, 95% CI 2.5‐10.6, P < .001) independently predicted surgery and worry about complications predicted avoidance of surgery (OR 0.5, 95% CI 0.2‐1.0, P = .037).ConclusionThis study, reflecting current clinical care, shows that patients' preferred treatment after using a PDA matches their eventual treatment choice in 86% of patients with gallstones or an inguinal hernia. In these patients, symptoms and patients' preference for surgery independently predicts eventual choice of surgery.
Highlights
An increasing number of patients want to be involved when a decision needs to be made between treatment options, commonly called shared decision making (SDM).[1]
A patient decision aid (PDA) informs a patient on treatment options and associated risks, and explores patients' values to determine what is most important for the individual patient
Workshops were organized to inspire about SDM, to explain how the PDAs work and to train communication skills to empower patients to participate in the decision-making process, assess patients' preferences and health values
Summary
An increasing number of patients want to be involved when a decision needs to be made between treatment options, commonly called shared decision making (SDM).[1]. Current PDAs consist of a personal value clarification exercise, which helps patients to identify their own values and find the treatment option most consistent with their preference. It is unknown which personal values are important in the preference for surgery.[13] Knowledge concerning factors influencing patients' preferences and treatment decisions are important to improve SDM.[14]. Gallbladder surgery and hernia repair are both, to a degree, considered to be examples of preference-sensitive care.[15] International guidelines support watchful waiting in selected patients if symptoms are mild and the condition does not show signs of potential complications.[16,17,18] Cholecystitis or biliary pancreatitis are potential complications of gallstones, while in case of an inguinal hernia, a complicated course may result in a bowel incarceration. We identified clinical factors and patient values that predicted a decision to have surgery
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