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

Shared decision making is defined as care that is evidence informed, respectful, and responsive to an individual patient's preferences.

By the year 2050, the number of adults 60 years of age or older will at least double.

Age-related risk factors and morbidities have been shown to predict mortality and morbidity following ventral hernia repair.

In 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.

The novel shared decision-making tool was designed based on the Agency for Healthcare Research and Quality suggested framework and included 5 key parts.

The tool was designed to be completed in real time during patient consultation and to act as a living document that patients could reference and bring to their surgery date or subsequent appointments.

Patients 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.

During 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%.

The median time of consultation was 9 minutes longer in the experimental group.

There 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.

75% 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.

There 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.

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.

The two most important treatment goals identified by patients in the experimental group were improving quality of life and preventing hernia recurrence.

Only 1 patient in the experimental group had previously discussed their code status with their doctor, and only 33% had a documented power of attorney.

100% 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.

For a 60-year-old gentleman with a primary 4 centimeter ventral hernia or primary umbilical hernia, asking 10 hernia surgeons might yield 10 different repair approaches.

Different hernia repair approaches have potential for different quality of life outcomes for the patient in terms of operation size, percentage of hernia recurrence, and potential options for the future.

It is unknown whether an IPOM repair is any different long term than a retromuscular repair.

The most important parts of the shared decision-making 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 loved ones.

A condensed form of the shared decision-making aid is currently being tested in another randomized controlled trial.