E400: Beta testing of a risk-stratified patient decision aid to facilitate shared decision-making for postoperative extended thromboprophylaxis in patients undergoing major abdominal surgery for cancer

We previously developed a novel patient decision aid (PtDA) to facilitate shared decision-making between patients and clinicians when deciding whether to use extended-duration thromboprophylaxis or not for four weeks after major abdominopelvic surgery for cancer. Our PtDA was found to be acceptable with patients and clinicians. The objective of this study was to build on our previous work by evaluating the effectiveness of our PtDA.


Methods:

Patients undergoing major abdominopelvic cancer surgery at an academic tertiary care-centre were enrolled in this pre- post-test study.  Outcomes were change in decisional conflict (primary), readiness to decide, decision-making confidence, and change in patient knowledge.  Participants were provided the appropriate risk-stratified PtDA according to their Caprini score in either the pre-operative or post-operative setting.  A sample size calculation determined 17 patients were required to demonstrate the PtDA meaningfully reduced decisional conflict. Statistical analysis used Wilcoxon matched-pairs signed ranks test for interval scaled measures.


Results:

A total of 17 patients were recruited. The median age was 68 years old (range 28-82) and the majority of patients were male (13/17, 76.5%). Based on the Caprini Score, 1 patient was low risk, 6 were moderate risk, 5 were high risk, and 5 were very high risk of developing a venous thromboembolism. The PtDA significantly reduced decisional conflict (median pre-PtDA decisional conflict score 2.37 out of 5 (range 1.00-3.81) versus post-PtDA score 1.3 (range 1.00-3.25), p< 0.01). The median score for confidence in decision-making was 86.4/100, (range 15.91-100), corresponding to high confidence.  Median knowledge scores increased from 50% (range 0-100%) to 75% (range 25-100%).  Median score for readiness to make a decision following the PtDA was 90/100 (range 55-100), indicating a high perceived level of preparedness to make a decision.


Conclusions: Our novel, risk-stratified, evidence-based PtDA on extended duration thromboprophylaxis following major abdominopelvic surgery significantly improved decision-making quality. Further research is needed to evaluate the usability and feasibility of this PtDA in the perioperative setting.