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The Impact of a Shared Decision-Making Tool for Appendicitis Treatment on Decisional Conflict
*Giana Davidson
2, *Sarah Monsell
3, *Joshua Rosen
2, *Erin Fannon
2, *Sara DePaoli
2, *Jonathan Kohler
1,
Dave Flum2
1Surgery, University of California, Davis, Davis, CA; 2Surgery, University of Washington, Seattle, WA; 3Biostatistics, University of Washington, Seattle, WA
For the treatment of appendicitis, antibiotics are an effective alternative to appendectomy, with both approaches associated with a different set of risks (e.g recurrence vs surgical complications) and benefits (e.g more rapid return to work vs decreased chance of readmission). Patients often have limited knowledge of these treatment options and may have preferences related to risks and benefits. In such cases, decision support tools (DST) that include video-based educational materials and questions to elicit patient preferences about outcome may be helpful. We developed a DST for appendicitis treatment (www.appyornot.org) and since introducing new treatments can cause decisional conflict, we aimed to describe the use of the DST and its impact on treatment preference and decisional conflict.
Methods: A retrospective cohort including people who self-reported current appendicitis and used the DST (2021-2023), including treatment preference before- and after- use of the DST (1-10 scale with 1-3 representing strong preference for antibiotics and 8-10 a strong preference for appendectomy). In a subset, demographic information and Ottawa Decisional Conflict Scale (DCS) (0 [no conflict]-100 [maximal conflict]) were reported after completing the DST.
Results: 5065 people from 66 countries (Figure 1) and all 50 states viewed at least the video portion of the DST. Among those who reported demographic information, median age was 39 years, 45% were female, 25% reported an appendicolith (n=2373 reported appendicolith status). 1244 completed the treatment preference question before and after the DST (Figure 2). Before the DST, 14% had a strong preference for antibiotics and 31% for appendectomy, with 55% undecided. After using the DST, the proportion in the undecided category decreased to 49% (p<.0001). 52% of those who completed the ODC (n=356) reported the lowest level of decisional conflict (<25) after using the DST; 5.1% had a ODC score of >50 and 2.5% had and ODC score of >75. “Feeling better soon� was an extremely important outcome for 57%, as was avoiding readmission (59%), recurrent appendicitis (57%), missing work (31%) and avoiding surgery (37%).
Conclusion: The publicly available appyornot.org DST is being widely used, reduced the proportion that was undecided, had a modest influence on those with strong treatment preferences and did not appear to increase decisional conflict. The use of this DST is now a component of a nationwide implementation program aimed at improving the way surgeons share information about appendicitis treatment options. If its use can be successfully implemented, this may be a model for improving communication about treatment for patients experiencing emergency health conditions.<scribe-shadow id="crxjs-ext" style="position: fixed; width: 0px; height: 0px; top: 0px; left: 0px; z-index: 2147483647; overflow: visible;"></scribe-shadow>
Figure 1. Use of the Decision Support Tool Worldwide (each point represents at least one use)
Figure 2. Preferences for treatment, before and after use of the decision support tool
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