Patient expectations and decisional regret in the management of ventral hernias.

Autor: Casson CA; Department of Surgery, Washington University in St. Louis, St. Louis, MO, USA. ccasson@wustl.edu., Kushner BS; Department of Surgery, Washington University in St. Louis, St. Louis, MO, USA., Holden TR; Department of Medicine, Division Of Geriatrics And Nutritional Science, Washington University in St. Louis, St. Louis, MO, USA., Majumder A; Department of Surgery, Division of Minimally Invasive Surgery, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8109, Saint Louis, MO, 63110, USA., Blatnik JA; Department of Surgery, Division of Minimally Invasive Surgery, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8109, Saint Louis, MO, 63110, USA., Holden SE; Department of Surgery, Division of Minimally Invasive Surgery, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8109, Saint Louis, MO, 63110, USA.
Jazyk: angličtina
Zdroj: Surgical endoscopy [Surg Endosc] 2024 Oct 16. Date of Electronic Publication: 2024 Oct 16.
DOI: 10.1007/s00464-024-11318-4
Abstrakt: Introduction: Older adult patients have many factors to contemplate when considering elective ventral hernia repair. In this study, we aimed to understand whether our novel shared decision-making (SDM) aid helped reduce this population's decisional regret when choosing hernia management strategy.
Methods: Patients ≥ 60 years of age presenting for ventral hernia evaluation were randomized to two groups. The experimental group had their visit guided by our novel SDM aid. All patients took a survey prior to consultation outlining their treatment expectations. All patients were called within 6 months to complete the Decision Regret Scale, which measures remorse after a healthcare decision.
Results: Seventy-two patients (36 control, 36 experimental) completed final follow-up. On initial expectations evaluation, 53 patients (74%) reported wanting surgical repair and 58 patients (81%) reported expecting surgical repair. Ultimately, 18 patients in the control group and 17 patients in the experimental group did not undergo surgery. The use of the SDM aid did not affect if patients chose observation (OR 0.44, p = 0.24) or result in a lower decision regret score (9.86 vs 9.31, p = 0.89). Surgery was associated with a lower decision regret score (3.38 vs 16.14; p = 0.001). Of those who did not undergo repair, patients initially wanting or expecting surgery had higher decision regret scores (22.83 vs 3.33, p < 0.001; 20.40 vs 5.50, p = 0.009). Nonoperative patients who chose observation had less regret than those needing medical optimization (9.50 vs 25.00, p = 0.04). There were no differences in decision regret scores based on initial wants or expectations for those who had surgical repair.
Conclusion: Decisional regret following ventral hernia management is associated with patients' expectations prior to initial surgical consultation. The use of a decisional aid did not lower decision regret scores. These findings emphasize the need for upfront expectation setting and longitudinal programs to help patients reach their treatment goals.
(© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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