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 5,000 名退伍军人在 VA 医院接受腹主动脉瘤 (AAA) 修复术。 随机试验，包括基于 VA 的开放与血管内修复 (OVER) 试验，发现 血管内 AAA 修复 (EVAR) 与较低的围手术期发病率和死亡率、较少的疼痛以及 住院时间比开放式手术修复 (OSR) 短，但是，OSR 更持久，长期治疗时间更少 晚期破裂等并发症，接受 EVAR 和 OSR 治疗的退伍军人在两年内的生存率相似 考虑到这些权衡，哪种方法最适合手术后仍然存在争议。 进行 AAA 修复的个别退伍军人，初步分析需求发现 VA 之间存在广泛差异 医院如何治疗 AAA 退伍军人 AAA 的治疗决策需要与退伍军人的意见保持一致。 例如，对于退伍军人来说，快速康复是最重要的并且是长期的。 耐久性是一个不太关心的问题，而治疗偏好与 EVAR 最为一致。 希望避免重复随访和后期重新干预的退伍军人有以下治疗偏好： 与 OSR 最接近。然而，虽然 VA 医院的 AAA 治疗类型各不相同，但尚不清楚是否如此。 这些待遇差异是由于退伍军人的偏好而发生的，或者与退伍军人的偏好无关 外科医生对修复类型的偏好描述很少，特别是对于进行治疗的外科医生。 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。 已经证明了 VA 中 AAA 修复类型的变化，并改进了定性方法以更好地理解 在这项提案中，退伍军人和外科医生的治疗决定是在一群退伍军人的候选者中进行的。 无论是维修类型（OSR 还是 EVAR），我们都将通过一项调查来探索退伍军人对 AAA 的了解和偏好 修复，并确定接受决策援助以及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，比较了两种改善退伍军人偏好的方法，并 AAA 的治疗方法：(1) 一个经过验证的决策辅助工具，通过测量退伍军人的调查来描述 AAA 修复类型 维修类型的偏好 - 与 (2) 单独的调查相比，登记的退伍军人将是其中任何一个的候选人。 血管内或开放式修复，并由 VA 医院的血管外科团队定期进行随访 在目标 1 中，我们将确定退伍军人对血管内或开放式修复的偏好，以及 确定与每种修复类型相关的领域 在目标 2 中，我们将比较退伍军人之间的一致性。 我们将确定决策辅助+调查组和仅调查组之间的偏好和修复类型。 我们的研究结果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始终处于 AAA 治疗决策的中心。 已经招募了20家渴望参与此项活动的退伍军人管理局医疗中心及其血管外科团队 帮助退伍军人做出最佳决定的重要试验。