Shared decision making (SDM) is ideally suited to abdominal wall surgery in older adults given the breadth of decision making required by the hernia surgeon and the impact on quality of life (QOL) by various treatment options. Given the paucity of literature surrounding SDM in hernia patients, the feasibility of a novel, formalized SDM aid/tool was evaluated in a pilot randomized trial.
Patients 60 years or older with a diagnosed ventral hernia were prospectively randomized at an academic hernia center. In the experimental arm, a novel SDM tool, based on the SHARE Approach, guided the consultation. Previously validated SDM assessments and patient’s hernia knowledge retention was measured.
Eighteen (18) patients were randomized (9 control and 9 experimental). Cohorts were well matched in age (p = 0.51), comorbidities (Charlson Comorbidity Score: p = 0.43) and frailty (mFI-11: p = 0.19; Risk Analysis Index: p = 0.33). Consultation time was 11 min longer in the experimental cohort (p < 0.01). There was a trend towards better Decisional Conflict Scores in the experimental group (p = 0.25) and the experimental cohort had improved post-visit retained hernia knowledge (p < 0.01). All patients in the experimental arm (100%) enjoyed working through the SDM aid/tool and felt it was a worthwhile exercise.
Incorporating a formalized SDM tool into a busy hernia surgical practice is feasible and well received by patients. In addition, early results suggest it improves retention of basic hernia knowledge and may reduce patient’s decisional conflict. Next steps include condensing the SDM tool to enhance efficiency within the clinic and beginning a large, randomized control trial.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price excludes VAT (USA)
Tax calculation will be finalised during checkout.
Kushner B et al (2020) A practical guideline for the implementation of shared decision-making in complex ventral incisional hernia repair. J Surg Res 259:387–392
Myckatyn TM et al (2020) Challenges and solutions for the implementation of shared decision-making in breast reconstruction. Plast Reconstr Surg Glob Open 8(2):e2645
Mulley AG, Trimble C, Elwyn G (2012) Stop the silent misdiagnosis: patients’ preferences matter. BMJ 345:e6572
Ubbink DT, Santema TB, Lapid O (2016) Shared decision-making in cosmetic medicine and aesthetic surgery. Aesthet Surg J 36(1):NP14-9
Warner DO et al (2015) Decision aid for cigarette smokers scheduled for elective surgery. Anesthesiology 123(1):18–28
Sepucha KR et al (2018) Standards for UNiversal reporting of patient Decision Aid Evaluation studies: the development of SUNDAE Checklist. BMJ Qual Saf 27(5):380–388
Neupane R et al (2017) Is old age a contraindication to elective ventral hernia repair? Surg Endosc 31(11):4425–4430
Docimo S Jr et al (2020) Evaluation of the use of component separation in elderly patients: results of a large cohort study with 30-day follow-up. Hernia 24(3):503–507
Saber AA et al (2008) Advanced age: is it an indication or contraindication for laparoscopic ventral hernia repair? JSLS 12(1):46–50
Kudsi OY et al (2020) Are elderly patients at high risk for postoperative complications after robotic ventral hernia repair? A propensity score matching analysis. Int J Med Robot 16(3):e2095
Kushner BS et al (2021) Geriatric assessment and medical preoperative screening (GrAMPS) program for older hernia patients. Hernia. https://doi.org/10.1007/s10029-021-02389-6
Oresanya LB, Lyons WL, Finlayson E (2014) Preoperative assessment of the older patient: a narrative review. JAMA 311(20):2110–2120
Watt J et al (2018) Identifying older adults at risk of harm following elective surgery: a systematic review and meta-analysis. BMC Med 16(1):2
Partridge JS, Harari D, Dhesi JK (2012) Frailty in the older surgical patient: a review. Age Ageing 41(2):142–147
Ahmed N, Mandel R, Fain MJ (2007) Frailty: an emerging geriatric syndrome. Am J Med 120(9):748–753
Joslyn NA et al (2018) Evidence-based strategies for the prehabilitation of the abdominal wall reconstruction patient. Plast Reconstr Surg 142(3 Suppl):21S-29S
Velanovich V et al (2013) Accumulating deficits model of frailty and postoperative mortality and morbidity: its application to a national database. J Surg Res 183(1):104–110
Uppal S et al (2015) Frailty index predicts severe complications in gynecologic oncology patients. Gynecol Oncol 137(1):98–101
Hall DE et al (2017) Development and initial validation of the risk analysis index for measuring frailty in surgical populations. JAMA Surg 152(2):175–182
Stiggelbout AM et al (2012) Shared decision making: really putting patients at the centre of healthcare. BMJ 344:e256
Berger Z (2015) Navigating the unknown: shared decision-making in the face of uncertainty. J Gen Intern Med 30(5):675–678
Makoul G, Clayman ML (2006) An integrative model of shared decision making in medical encounters. Patient Educ Couns 60(3):301–312
Wilmore DW (2002) From Cuthbertson to fast-track surgery: 70 years of progress in reducing stress in surgical patients. Ann Surg 236(5):643–648
Agency for Healthcare Research and Quality, R., MD. The SHARE Approach—Essential Steps of Shared Decisionmaking: Quick Reference Guide.; Available from: https://www.ahrq.gov/health-literacy/curriculum-tools/shareddecisionmaking/tools/tool-1/index.html
Stegmann ME et al (2019) Using the Outcome Prioritization Tool (OPT) to assess the preferences of older patients in clinical decision-making: a review. Maturitas 128:49–52
Anderson LA, Dedrick RF (1990) Development of the Trust in Physician scale: a measure to assess interpersonal trust in patient-physician relationships. Psychol Rep 67(3 Pt 2):1091–1100
O’Connor AM (1995) Validation of a decisional conflict scale. Med Decis Making 15(1):25–30
La Monica EL et al (1986) Development of a patient satisfaction scale. Res Nurs Health 9(1):43–50
Brodney S et al (2019) Comparison of three measures of shared decision making: SDM Process_4, CollaboRATE, and SURE Scales. Med Decis Making 39(6):673–680
Hess EP et al (2016) Shared decision making in patients with low risk chest pain: prospective randomized pragmatic trial. BMJ (Clin Res ed) 355:i6165–i6165
Elwyn G et al (2013) Developing CollaboRATE: A fast and frugal patient-reported measure of shared decision making in clinical encounters. Patient Educ Couns 93(1):102–107
Charlson ME et al (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383
Harris PA et al (2009) Research electronic data capture (REDCap)-A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42(2):377–381
Harris PA et al (2019) The REDCap consortium: building an international community of software platform partners. J Biomed Inform 95:103208
Caglia P et al (2014) Incisional hernia in the elderly: risk factors and clinical considerations. Int J Surg 12(Suppl 2):S164–S169
Al Chalabi H et al (2015) A systematic review of laparoscopic versus open abdominal incisional hernia repair, with meta-analysis of randomized controlled trials. Int J Surg 20:65–74
Carroll SL et al (2017) Evaluating the feasibility of conducting a trial using a patient decision aid in implantable cardioverter defibrillator candidates: a randomized controlled feasibility trial. Pilot Feasibility Stud 3:49
Stacey D et al (2017) Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 4:001431
Fagerlin A et al (2006) An informed decision? Breast cancer patients and their knowledge about treatment. Patient Educ Couns 64(1–3):303–312
Ankuda CK et al (2014) Measuring critical deficits in shared decision making before elective surgery. Patient Educ Couns 94(3):328–333
Uzzaman MM et al (2012) Evaluation of patient’s understanding and recall of the consent process after open inguinal hernia repairs. Int J Surg 10(1):5–10
Eklund A et al (2010) Chronic pain 5 years after randomized comparison of laparoscopic and Lichtenstein inguinal hernia repair. Br J Surg 97(4):600–608
Nguyen DK, Amid PK, Chen DC (2016) Groin pain after inguinal hernia repair. Adv Surg 50(1):203–220
Bay-Nielsen M et al (2001) Pain and functional impairment 1 year after inguinal herniorrhaphy: a nationwide questionnaire study. Ann Surg 233(1):1–7
de Mik SML et al (2018) Systematic review of shared decision-making in surgery. Br J Surg 105(13):1721–1730
Maloney SR et al (2020) The impact of component separation technique versus no component separation technique on complications and quality of life in the repair of large ventral hernias. Surg Endosc 34(2):981–987
Pauli EM, Rosen MJ (2013) Open ventral hernia repair with component separation. Surg Clin North Am 93(5):1111–1133
Kao AM et al (2018) Prevention and treatment strategies for mesh infection in abdominal wall reconstruction. Plast Reconstr Surg 142(3 Suppl):149S-155S
The authors have no additional acknowledgements.
No funding was used for this study.
Conflict of interest
Dr. Blatnik has an honorary speaking and teaching appointment with Bard International (BD) and Intuitive Surgical, and provides research support for Ethicon and Cook Medical. The other authors have no conflicts to report.
This study was approved by our institutional review board (IRB).
All patients underwent verbal informed consent prior to enrollment.
Human and animal rights
All procedure were approved by the Washington University in St. Louis Institutional Review Board.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Kushner, B.S., Holden, T., Han, B. et al. Randomized control trial evaluating the use of a shared decision-making aid for older ventral hernia patients in the Geriatric Assessment and Medical Preoperative Screening (GrAMPS) Program. Hernia 26, 901–909 (2022). https://doi.org/10.1007/s10029-021-02524-3
- Ventral hernias
- Inguinal hernia
- Geriatric syndromes
- Mild cognitive impairment
- Shared decision making