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299 Test of an in-consult patient decision aid for choice of management following endoscopic removal of malignant colorectal polyps
  1. Helene J Würtz1,2,3,4
  1. 1Center for Shared Decision Making, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
  2. 2Department of Surgery at Vejle Hospital, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
  3. 3Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
  4. 4Colorectal Cancer Center South at Vejle Hospital, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark

Abstract

Introduction Making the choice of management once an apparently benign colorectal polyp proves to be malignant constitutes a dilemma. The choice between subsequent bowel resection or observation strategy is challenging as both options include a tradeoff between pros and cons. Although international recommendations support the clinical decision-making based on histopathological risk factors such as tumor size, grade and lymphatic invasion, there are larger series published concluding that roughly 75% of the resected bowel specimens are without residual cancer.1 The use of a Patient Decision Aid (PtDA) could be an aid in these consultations regarding choice of management of this preference-sensitive decision in order to increase patient involvement in decision-making. The aim of the study is to evaluate whether there is a significant increase in patient involvement in decision-making when comparing an unexposed cohort to a PtDA exposed cohort.

Methods This prospective cohort study has a sample size of 50 patients and compares an unexposed control cohort with a cohort exposed to an in-consult PtDA administered by experienced senior surgeons. The PtDA was developed with patient participation and according to International Patient Decision Aid Standards recommendations,2 and the OPTION12 (’observing patient involvement’) scale3 is used as the validated observation instrument to assess the level of patient involvement in decision-making occurring.

Results Preliminary data show a mean OPTION12 scale score of 17 in the first 11 patients in the unexposed cohort whilst the exposed group of 6 patients included so far have a mean score of 14.5.

Discussion These are only preliminary results and under half of the exposed group have been included. Conclusion

The preliminary data indicate that the use of a PtDA administered by experienced senior surgeons in the gastrointestinal surgical field does not increase the level of patient involvement in decision-making when used in preference-sensitive care.

References

  1. Ikematsu H, Yoda Y, Matsuda T, Yamaguchi Y, Hotta K, Kobayashi N, Fujii T, Oono Y, Sakamoto T, Nakajima T, Takao M, Shinohara T, Murakami Y, Fujimori T, Kaneko K Saito Y. Long-term outcomes after resection for submucosal invasive colorectal cancers. Gastroenterology, 2013;1:44(3):551–9; quiz e14.

  2. Holmes-Rovner M. International Patient Decision Aid Standards (IPDAS): beyond decision aids to usual d esign of patient education materials. Health Expect, 2007;10(2):103–7.

  3. Elwyn G, et al. The OPTION scale: measuring the extent that clinicians involve patients in decision-making tasks. Health Expect, 2005;8(1):34–42.

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