Vascular Mock Oral Exams: A Review of the 8-Year Experience of the SAVS Mock Oral Program

Abstract

categoric variables or mean 6 standard deviation for continuous variables. Categoric responses are presented as median (interquartile range) based on a 1-5 ordinal scale. Results: The participants were 74 patients undergoing intervention for abdominal aortic aneurysm (n 1⁄4 20), hemodialysis access (n 1⁄4 14), carotid stenosis (n 1⁄4 20), and peripheral arterial disease (n 1⁄4 20). Mean age was 68.86 12.4 years, 43% were women, and 26% were African American. Highest educational level was college or graduate school for 35% of participants, 61% had computer access, and 41% regularly used e-mail. Participants identified providers as the most important information sources (1 [1, 1] for doctors and 2 [1, 3] for nurse practitioners, where 11⁄4 “very important” and 51⁄4 “not important”), whereas family and friends, writtenmaterials, and other patients were less important (3 [1, 5], 3 [2, 4], and 3 [2, 5], respectively), and television/video and internet resources were least important (4.5 [3, 5] and 5 [3, 5], respectively). Although participants had high levels of confidence in provider recommendations (1 [1, 1] for all procedure categories, where 11⁄4 “very satisfied” and 5 1⁄4 “not satisfied”), they had a strong preference to discuss all potential treatment options (1 [1, 1], where 1 1⁄4 “strongly agree” and 5 1⁄4 “strongly disagree”) and to choose their treatment together with their doctor (1 [1, 2]) as opposed to only discussing the recommended treatment (2 [1, 3]) or delegating selection to the doctor alone (2 [1, 3]). Patients undergoing hemodialysis access and abdominal aortic aneurysm procedures most often reported discussion of more than one option (1.5 [1, 3] and 1.5 [1, 5], respectively), whereas discussion of multiple options was less common for peripheral arterial disease (2 [1, 3.5]) and carotid stenosis (3 [1, 5]). Thirty-seven participants (50%) considered their first treatment successful, 27 (36.5%) considered another subsequent treatment successful, and 10 (13.5%) considered none successful. Conclusions: Patients experience varying participation levels in decision making for vascular procedures and often believe that their treatments are unsuccessful. Although patients consider providers an important source of information and have confidence in their recommendations, they prefer to discuss all treatment options being considered. Patients also prefer shared decision making over complete delegation to the provider. Increasing patient involvement in treatment decisions has potential to improve patient satisfaction but may require tools to facilitate more active participation. Potential impacts on other outcomes remains to be determined.