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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 volume 26, pages 901–909 (2022)Cite this article

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

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Acknowledgements

The authors have no additional acknowledgements.

Funding

No funding was used for this study.

Author information

Authors and Affiliations

  1. Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, Saint Louis, MO, 63110, USA

    B. S. Kushner, B. Han, M. Sehnert, A. Majumder, J. A. Blatnik & S. E. Holden

  2. Department of Medicine, Division of Geriatrics and Nutritional Science, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, Saint Louis, MO, 63110, USA

    T. Holden

Authors
  1. B. S. Kushner
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  2. T. Holden
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  3. B. Han
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  4. M. Sehnert
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  5. A. Majumder
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  6. J. A. Blatnik
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  7. S. E. Holden
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Contributions

BK, SH, TH contributed to the formulation of the manuscript, writing, and editing. BH, AM, JB, and MS contributed to the study design and the editing.

Corresponding author

Correspondence to B. S. Kushner.

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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.

Ethical approval

This study was approved by our institutional review board (IRB).

Informed consent

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.

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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

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  • DOI: https://doi.org/10.1007/s10029-021-02524-3

Keywords

  • Ventral hernias
  • Inguinal hernia
  • Geriatric syndromes
  • Frailty
  • Age
  • Mild cognitive impairment
  • Shared decision making