Use of a Novel Clinical Decision-Making Tool in Vestibular Schwannoma Treatment

ObjectiveTo determine the usefulness of a personalized tool and its effect on the decision-making process for those with vestibular schwannoma (VS).Study DesignProspective study.SettingSingle institution, academic tertiary care lateral skull base surgery program.PatientsPatients diagnosed with VS.InterventionsA comprehensive clinical decision support (CDS) tool was constructed from a previously published retrospective patient-reported data obtained from members of the Acoustic Neuroma Association from January to March 2017. Demographic, tumor, and treatment modality data, including associated side effects, were collected for 775 patients and integrated in an interactive and personalized web-based tool.Main Outcome MeasuresPre- and posttool questionnaires assessing the process of deciding treatment for VS using a decisional conflict scale (DCS) and satisfaction with decision (SWD) scale were compared.ResultsA pilot study of 33 patients evaluated at a single institution tertiary care center with mean +/- SD age of 63.9 +/- 13.5 years and with average tumor size of 7.11 +/- 4.75 mm were surveyed. CDS implementation resulted in a mean +/- SD total DCS score decrease from 43.6 +/- 15.5 to 37.6 +/- 16.4 (p < 0.01) and total SWD score increase from 82.8 +/- 16.1 to 86.2 +/- 14.4 (p = 0.04), indicating a significant decrease in decisional conflict and increase in satisfaction.ConclusionsImplementing a decision-making tool after diagnosis of VS reduced decisional conflict and improved satisfaction with decision. Patients considered the tool to be an aid to their medical knowledge, further improving their comfort and understanding of their treatment options. These findings provide a basis for developing predictive tools that will assist patients in making informed medical decisions in the future.