Alignment of Treatment Preferences and Repair Type for Veterans with AAA

AAA 退伍军人的治疗偏好和修复类型的一致性

• 批准号: 10016116
• 负责人: Philip P Goodney
• 金额: --
• 依托单位: WHITE RIVER JUNCTION VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-05-01 至 2021-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10016116
• 关键词: Abdominal Aortic Aneurysm; Agreement; Aortic Aneurysm; Blood Vessels; Caliber; Client satisfaction; Clinic; Clinic Visits; Cluster randomized trial; Consent; Control Groups; Decision Aid; Enrollment; Ensure; Future; Goals; Growth; Health Personnel; Hospitals; Individual; Intervention; Knowledge; Length of Stay; Measures; Medical center; Methods; Office Surgery; Operative Surgical Procedures; Pain; Patients; Postoperative Period; Principal Investigator; Qualitative Methods; Recovery; Reporting; Research Design; Risk; Rupture; Ruptured Aneurysm; Site; Surgeon; Surveys; Uncertainty; Variant; Veterans; Visit; Work; anxious; base; cognitive interview; cohort; disability; follow-up; instrument; perioperative morbidity; perioperative mortality; preference; primary outcome; randomized trial; recruit; repaired; satisfaction; screening; secondary outcome; shared decision making; treatment center; treatment choice; trial comparing

Nearly 5,000 Veterans undergo abdominal aortic aneurysm (AAA) repair each year in VA hospitals. Randomized trials, including the VA-based Open Versus Endovascular Repair (OVER) Trial, have found endovascular AAA repair (EVAR), is associated with lower perioperative morbidity and mortality, less pain, and shorter length of stay than open surgical repair (OSR) However, OSR is more durable, has fewer long-term complications such as late rupture, and Veterans treated with EVAR and OSR have similar survival within two years following surgery. Given these tradeoffs, controversy remains as to which method is best suited for an individual Veteran who AAA repair, and preliminary analyses needs have found broad variations across VA hospitals in how Veterans are treated for AAA. Treatment decisions for AAA need to be aligned with Veterans' preferences. For example, a Veteran for whom a rapid recovery is of primary importance and long-term durability a lesser concern has a treatment preference which aligns most closely with EVAR. Similarly, a Veteran who wishes to avoid repeated follow-up visits and late re-interventions has a treatment preference that aligns most closely with OSR. However, while AAA treatment type varies across VA hospitals, it is unknown if these treatment variations occurs as a result of Veterans preferences, or independent of Veterans' preferences. Surgeon preferences for repair type have been poorly described, especially for surgeons treating Veterans. In preliminary work, we have performed observational analyses, surveys, and cognitive interviews. This works has demonstrated variation in AAA repair type in VA and refined qualitative methods to better understand Veterans' and surgeons’ treatment decisions. In this proposal, in a cohort of Veterans who are candidates for either repair type (OSR or EVAR), we will use a survey explore Veterans' knowledge and preferences for AAA repair, and determine if Veterans who receive a decision aid as well as the survey are more likely to receive their treatment choice. We describe a cluster-randomized trial comparing two ways to better align Veterans' preferences and treatments for AAA: (1) a validated decision aid describing AAA repair types with a survey measuring Veterans' preference for repair type -- versus (2) the survey alone. Enrolled Veterans will be candidates for either endovascular or open repair, and be followed at VA hospitals by vascular surgery teams who regularly perform both types of repair. In Aim 1, we will determine Veterans' preferences for endovascular or open repair and identify domains associated with each repair type. In Aim 2, we will compare agreement between Veterans' preferences and repair type between the decision aid+survey and survey-alone groups. We will identify factors associated with agreement. Our findings will be reported to the National Surgery Office Vascular Surgery Advisory Board to help ensure Veterans' preferences remain at the center of AAA treatment decisions. We have recruited 20 VA Medical Centers and their vascular surgery teams who are anxious to participate in this important trial to help Veterans make the best decisions.

每年，近5,000名退伍军人接受腹部主动脉瘤（AAA）维修。 随机试验，包括基于VA的开放与血管内修复（过度）试验，发现 血管内AAA修复（EVAR）与较低时期的发病率和死亡率相关，疼痛较小，并且 比开放式手术修复（OSR）较短，OSR更耐用，长期较少 诸如晚期破裂和用EVAR和OSR处理的退伍军人之类的并发症在两个人中具有相似的生存率 手术后的几年。鉴于这些权衡，关于哪种方法最适合一种的争议仍然存在 AAA修复以及初步分析需求的个人退伍军人发现了VA的广泛差异 医院如何治疗AAA。 AAA的治疗决定必须与退伍军人的一致 偏好。例如，一个迅速恢复至关重要的退伍军人 持续时间较小的关注点具有治疗偏好，该偏好与EVAR最紧密地保持一致。同样， 希望避免重复后续访问和后​​期重新干预的退伍军人具有治疗偏好， 与OSR最紧密地对齐。但是，尽管AAA治疗类型在VA医院各不相同，但尚不清楚 这些治疗变化是由于退伍军人的偏好或与退伍军人无关的结果。 偏好。外科医生对维修类型的偏好的描述很差，特别是对于治疗外科医生 退伍军人。 在初步工作中，我们进行了观察分析，调查和认知访谈。这有效 已经证明了VA中AAA修复类型的差异和精制定性方法，以更好地理解 退伍军人和外科医生的治疗决定。在此提案中，在一群退伍军人中 维修类型（OSR或EVAR），我们将使用调查探索退伍军人对AAA的知识和偏好 维修，并确定接受决策援助以及调查的退伍军人是否更有可能接受 他们的治疗选择。 我们描述了一项集群随机试验，该试验比较了两种方法，以更好地调整退伍军人的偏好和 AAA的治疗方法：（1）通过测量退伍军人的调查来描述AAA维修类型的经过验证的决策援助 对维修类型的偏爱 - 与（2）单独进行调查。入学的退伍军人将成为候选人 血管内或开放维修，并在VA医院进行血管外科手术团队，他们定期表演 两种维修。在AIM 1中，我们将确定退伍军人对血管内或开放维修的偏好，以及 识别与每种维修类型相关的域。在AIM 2中，我们将比较退伍军人之间的协议 偏好和维修类型在决策AID+调查与独自调查组之间。我们将确定因素 与协议相关。我们的发现将报告给国家手术办公室血管手术 咨询委员会旨在帮助确保退伍军人的偏好保持在AAA治疗决定的中心。我们 急于参与此活动的20名VA医疗中心及其血管外科手术团队 重要的试验，以帮助退伍军人做出最佳决定。