1144. Mixed-methods Approach to Implementing and Evaluating a Decision Support Intervention in the Context of Unruptured Cerebral Aneurysms

Authors: Josh Feler; Sammuel Sommaruga, MD; Branden Cord, MD, PhD; Ryan Hebert, MD; Amanda Sammann, MD, MPH; Charles Matouk, MD; David Hwang, MD (San Francisco, CA)

Introduction: Deciding to treat an unruptured cerebral aneurysm involves discussion with patients regarding outcomes data and personal attitudes towards risks of rupture versus procedural complication. Research has suggested high rates of inter-provider variability in recommendations during these discussions and physician-patient discordance regarding the perceived plan immediately post-consultation. Patient decision aids facilitating discussions for other elective surgeries have improved patients’ knowledge, risk comprehension, and congruency between personal values and care choices. A decision support intervention for use in the context of unruptured aneurysms will be implemented in two phases: first, a mixed qualitative and quantitative study will investigate factors considered in decision making processes by patients and providers and obstacles to value-informed decision making. Second, findings will inform the design of a decision support intervention to be tested at multiple centers. Methods: Semi-structured interviews will be carried out with 40 patients and 5 expert providers from multiple sites. Findings will be validated in large-sample (n=500) surveys using the GfK survey platform. An initial decision support intervention will be piloted with at least 20 patients and 5 providers for cycles of feedback and refinement. Finally, the intervention will be validated in a pre-post study at multiple centers. Results: Findings of mixed-methods investigation will be reported by theme. In phase 2 validation, primary outcome metrics will include validated scores of patient decisional conflict, accuracy of patient risk estimation, and patient-physician concordance regarding the plan immediately post-consultation. Secondary measures will include consultation duration, a validated score of physician communication quality, and intervention chosen. Decisional regret will be assessed via a validated scale one-month post-consultation. Conclusions: Findings from the mixed-methods study will provide a basis for future discussion of decision making in elective neurosurgery. We expect our intervention to decrease patient decisional conflict, improve accuracy of patient risk estimation, and only moderately increase consultation time.