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▶Ep 6 · 0:29
As previous groups have found that for every point decrease on the decisional conflict scale, there was an associated 19% less likelihood to blame doctors for poorer outcomes, therefore, our difference of 6 points was certainly clinically meaningful.
the most important parts of the aid was, was not actually going through all the decision-making with them, but actually having it written down. Um, for the patient itself so that they could take home and they could discuss with their loved ones.
Best of the Best Gen Surg - Pilot Randomized Control Trial Evaluating the Use of a Shared Decision Making Aid for Older Ventral Hernia Patients - Dr. Kushner
▶Ep 6 · 0:29
quoteBy the year 2050, the number of adults 60 years of age or older will at least double.↗
▶Ep 6 · 0:29
guidelineShared decision making is defined as care that is evidence informed, respectful, and responsive to an individual patient's preferences↗
▶Ep 6 · 0:29
epidemiologicalBy the year 2050, the number of adults 60 years of age or older will at least double↗
▶Ep 6 · 0:29
clinicalAge-related risk factors and morbidities have been shown to predict mortality and morbidity following eventual hernia repair↗
▶Ep 6 · 0:29
clinicalIn phase 1 of the GRAMPS program, age-related risk factors in the elective hernia population were demonstrated to be both common and present a real challenge to the hernia surgeon↗
▶Ep 6 · 0:29
clinicalThe novel shared decision making tool was designed based on the Agency for Healthcare Research and Quality suggested framework for incorporating shared decision making into practice and included 5 key parts↗
▶Ep 6 · 0:29
clinicalThe tool was designed to be completed in real time during the patient consultation and to act as a living document that patients could reference and bring to their surgery date or subsequent appointments↗
▶Ep 6 · 0:29
clinicalThe median time of consultation was 9 minutes longer in the experimental group↗
▶Ep 6 · 0:29
clinicalThere was higher retention of key hernia knowledge in the experimental group when patients were given a follow-up hernia quiz one week after the initial consultation↗
▶Ep 6 · 0:29
clinical75% of patients in the experimental group perceived their visit as shared decision making as compared to only 50% in the control group when using the collaborate scale↗
▶Ep 6 · 0:29
clinicalThere was a meaningful clinical decrease in the decisional conflict of patients in the experimental group, with a difference of 6 points on the decisional conflict scale↗
▶Ep 6 · 0:29
clinicalPrevious groups have found that for every point decrease on the decisional conflict scale, there was an associated 19% less likelihood to blame doctors for poorer outcomes↗
▶Ep 6 · 0:29
clinicalThe two most important treatment goals identified by patients in the experimental group were improving quality of life and preventing hernia recurrence↗
▶Ep 6 · 0:29
clinicalOnly 1 patient previously had discussed their code status with their doctor, and only 33% had a documented power of attorney↗
▶Ep 6 · 0:29
clinical100% of patients in the experimental group both enjoyed the shared decision making aid and found it to be a useful exercise when asked about it on exit interview↗
▶Ep 6 · 0:29
quoteShared decision making defined as care that is evidence informed, respectful, and responsive to an individual patient's preferences is ideally suited to the complex abdominal wall surgery.↗
▶Ep 6 · 0:29
quoteAs previous groups have found that for every point decrease on the decisional conflict scale, there was an associated 19% less likelihood to blame doctors for poorer outcomes, therefore, our difference of 6 points was certainly clinically meaningful.↗
▶Ep 6 · 0:29
quote100% of patients in the experimental group both enjoyed the shared decision making aid and found it to be a useful exercise when asked about it on exit interview.↗
▶Ep 6 · 0:29
clinicalPatients were excluded if they were deemed to be a non-operative candidate despite potential future prehabilitation options or who had a documented history of cognitive impairment↗
▶Ep 6 · 0:29
clinicalDuring the 4 month trial enrollment period, 18 patients were consented and randomized, half to each of the experimental and control groups, with overall recruitment percentage greater than 95%↗
▶Ep 6 · 6:54
clinicalThe IRB required telling patients after the fact that those in the control group were withheld the actual aid↗
▶Ep 6 · 6:54
clinicalPatients were called and told about the study looking at shared decision-making and that they would be randomized to either a newer tool or the standard shared decision-making visit that surgeons typically do↗
▶Ep 6 · 6:54
clinicalPatients eligible for the study were identified about a week or two before their first hernia clinic by looking at schedules of the three main hernia surgeons at the institution↗
▶Ep 6 · 9:47
opinionFor a 60-year-old gentleman with a primary 4 centimeter ventral hernia or primary umbilical hernia, asking 10 hernia surgeons might get 10 different answers on how to repair it↗
▶Ep 6 · 9:47
clinicalDifferent hernia repair approaches have potential for different quality of life for the patient in terms of how big the operation would be, the percentage of hernia recurrence, and potential options for the future↗
▶Ep 6 · 12:11
quotethe most important parts of the aid was, was not actually going through all the decision-making with them, but actually having it written down. Um, for the patient itself so that they could take home and they could discuss with their loved ones.↗
▶Ep 6 · 12:11
clinicalThe next phase is a randomized controlled trial currently running with a condensed form of the shared decision-making aid↗
▶Ep 6 · 12:11
clinicalThe most important parts of the aid were not actually going through all the decision-making with patients, but having it written down for the patient to take home and discuss with their loved ones↗
