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.

每年有近5000名退伍军人在退伍军人医院接受腹主动脉瘤(AAA)修复。 随机试验，包括基于VA的开放与血管内修复(OVER)试验，已经发现 血管内AAA修复术(EVAR)与较低的围手术期发病率和死亡率、较少的疼痛和 与开放外科修复术(OSR)相比，OSR的住院时间更短，但OSR更耐用，长期修复时间更短 晚期破裂等并发症，以及接受EVAR和OSR治疗的退伍军人在两年内的存活率相似 手术后的几年。考虑到这些权衡，关于哪种方法最适合于 AAA维修和初步分析需求的退伍军人个人在退伍军人管理局发现了广泛的差异 退伍军人如何接受AAA治疗的医院。AAA的治疗决定需要与退伍军人的决定保持一致 偏好。例如，对一名退伍军人来说，快速恢复是首要的和长期的 耐受性是一个不那么令人担忧的问题，它的治疗偏好与EVAR最接近。类似地，一个 希望避免重复随访和延迟再次干预的退伍军人有治疗偏好， 最接近OSR。然而，尽管不同退伍军人医院的AAA治疗类型不同，但尚不清楚 这些治疗变化是退伍军人偏好的结果，或者与退伍军人的 偏好。外科医生对修复类型的偏好一直没有得到很好的描述，特别是对于治疗 退伍军人。 在前期工作中，我们进行了观察分析、调查和认知访谈。这很管用 已证明VA的AAA修复类型存在差异，并改进了定性方法以更好地了解 退伍军人和外科医生的治疗决定。在这项提案中，在一群退伍军人中，他们是候选人 无论是维修类型(OSR还是EVAR)，我们将使用一项调查来探索退伍军人对AAA的知识和偏好 修复，并确定接受决策援助和调查的退伍军人是否更有可能获得 他们的治疗选择。 我们描述了一项整群随机试验，比较了两种方法更好地匹配退伍军人的偏好和 AAA的治疗：(1)通过测量退伍军人的调查，描述AAA修复类型的有效决策辅助 对维修类型的偏好--而不是(2)只进行调查。已登记的退伍军人将成为 血管内修复或开放修复，在退伍军人医院由血管外科团队定期执行 两种类型的修复。在目标1中，我们将确定退伍军人对血管内修复或开放修复的偏好 确定与每种维修类型相关联的域。在目标2中，我们将比较退伍军人 决策辅助+调查和单独调查组之间的偏好和修复类型。我们将确定因素 与协议相关的。我们的发现将报告给国家外科办公室血管外科 咨询委员会，帮助确保退伍军人的偏好仍然处于AAA治疗决定的中心。我们 已经招募了20个退伍军人医学中心和他们的血管外科团队，他们渴望参与到这一活动中来 帮助退伍军人做出最佳决策的重要试验。