Informed consent for abdominal aortic aneurysm repair: The patient's perspective

Objective: Whether or not to undergo surgery for abdominal aortic aneurysm (AAA), and whether to have open or endovascular repair (EVAR), is a complex decision that relies heavily on patient preferences, and yet little is known about the patient perspective on informed consent in this context. This study explores patients' views on their decision-making processes and the quality of surgeon-patient communication during informed consent for AAA repair. Design of study: We conducted in-depth interviews with AAA patients (n = 20) who underwent open AAA repair, endovascular repair, or declined surgery. Data were independently transcribed and analyzed by a team of individuals with diverse backgrounds, using the constant comparative method of analysis and systematic coding procedures. Setting. Patients who had seen surgeons from academic, private practice, and VA settings were interviewed. Main outcome measure: Patients' opinions regarding the nature, scope, and content of informed consent for AAA repair. Results: We identified four central themes characterizing patients' experiences with informed consent for AAA repair: 1) patients did not appreciate the scope of their options; 2) patients demonstrated that they were not adequately informed prior to making a decision; 3) patients differed in the scope and content of information they desired during informed consent; and 4) trust in the surgeon had an impact on the informed consent process. Conclusion: Our research highlights the limitations of the informed consent encounter in the current clinical context, and points to several ways in which informed consent could be improved. Adapting the informed consent encounter to incorporate the patient's perspective is critical in order to ensure that the decision regarding AAA repair is consistent with the patient's informed preference.