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Decision Aids

By: Steven Young, M.D.; Joseph Answine, M.D.; Fred E. Shapiro, D.O., FASA

updated May 5, 2020

Decision aids can help patients better understand anesthetics, informed consent for anesthesia and procedures in anesthesia.

There is a potential to reduce complaints against physicians regarding informed consent when using decision aids to engage patients in shared decision making.1/ Informed consent starts with sharing basic knowledge with the patient, followed by providing enough time for the patient to decide. The outcome of the decision should be one that is aligned with the patient’s philosophies, principles and priorities.2 Shared decision making, with up-to-date evidence-based information about the alternative therapies, can save the health care system money compared to usual care for a single condition and a single decision.3 Research on decision aids show that there is increased patient engagement and knowledge about anesthesia. However, patients still leave the decision to their doctors.4,5

What you should know

Decision aids are being studied for patients as well as anesthesiologists. The Centers for Disease Control and Prevention (CDC) developed a decision aid on smoking cessation.6 They recruited 100 patients who were receptive to quitting smoking. However, at the end of the study there was no impact on smoking cessation. There was a publication on decision aids on smoking cessation for elective surgery by Warner et al.7 They found 130 patients receptive to the information, but ultimately showed no impact on quitting.

The American Society for Regional Anesthesia (ASRA) put forth a consensus statement on the use of regional anesthesia in the setting of patients receiving antithrombotic or thrombolytic therapy. There was concern that anesthesia providers were not properly using these guidelines. McEvoy et al studied this by developing an electronic decision aid and comparing the knowledge gained when using the decision aid compared to traditional methods.8 The authors showed there was improved knowledge among trainees and faculty who used the decision aid.

What the ASA is doing

The ASA Committee on Patient Safety and Public Education (CPSE) has developed two decision aids: Decision Aid on Epidural and Spinal Anesthesia and Decision Aid on Peripheral Nerve Blocks.9,10 These aids are meant to be used in the pre-op clinic by anesthesiologists, residents and nurse practitioners to educate patients well in advance before their surgery and procedure. These aids may help the patient reach a more informed decision about their anesthetic plan in conjunction with the anesthesia and surgical team.

A monitored anesthesia care (MAC) decision aid, developed in conjunction between the ASA CPSE and Beth Israel Deaconess Medical Center Department of Anesthesia as a mobile app, is in pilot testing for patients undergoing breast surgery. The primary objective of the study is to evaluate patient understanding of sedation versus general anesthesia and engagement in the anesthetic plan decision-making process. Preliminary data show that there is an improvement in correctly answered questions regarding anesthesia after implementation of the mobile app.

The ASA has developed a website (Made For This Moment®) in simple language dedicated for patients. These topics about anesthesia, pain and surgery are meant to serve as another source of information for patients. What is anesthesia? What is pain? How can you prepare for surgery? Hopefully, the website may help set expectations for patients and allow them to ask their anesthesiologists and surgeons more informed questions.

There are multiple printable two-page resource cards for patients on surgical pain management, surgery preparation, labor pain and role of physician anesthesiologists.14

The ASA CPSE recently wrote an International Anesthesiology Clinics (IAC) chapter on “Decision Aids—the Role of the Patient in Perioperative Safety” that was published in June 2019.15

REFERENCES

  1. Posner KL, Severson J, Domino KB. The role of informed consent in patient complaints: Reducing hidden health system costs and improving patient engagement through shared decision making. J Healthc Risk Management. 2015;35(2):38-45. doi: 10.1002/jhrm.21200
  2. Cooper Z, Sayal P, Abbett SK, Neuman MD, Rickerson EM, Bader AM. A conceptual framework for appropriateness in surgical care: reviewing past approaches and looking ahead to patient-centered shared decision making. Anesthesiology. 2015;123:1450-1454. doi: 10.1097/ALN. 0000000000000899
  3. O’Connor AM, Llewellyn-Thomas HA, Flood AB. Modifying unwarranted variations in health care: shared decision making using patient decision aids. Health Aff (Millwood). 2004;35. doi: 10.137/hlthaff.var.63
  4. Posner KL, Mincer SL, Harvey AE, Xue AH, Van Norman GA, Domino KB. Regional anesthesia decision aids in the preanesthesia clinic improve patient engagement and knowledge (PDF). Abstract presented at: ASA; October 25, 2015. Accessed December 11, 2018.
  5. Posner KL, Van Norman GA, Mincer SL, Harvey AE, Domino, KB. Regional anesthesia: patients want information but most will leave anesthetic choice to their doctors. Abstract presented at: ASA; Oct 2014. Accessed December 11, 2018.
  6. Agarwal SD, Kerwin M, Meindertsma J, Wolf AMD. A novel decision aid to encourage smoking cessation among patients at an urban safety net clinic. Prev Chronic Dis. 2018;15:E124. doi: 10.5888/pcd15.180215
  7. Warner DO, LeBlanc A, Kadimpati S, Vickers KS, Shi Y, Montori VM. Decision aid for cigarette smokers scheduled for elective surgery. Anesthesiology. 2015;123(1):18-28. doi: 10.1097/ALN.0000000000000704
  8. McEvoy MD, Hand WR, Stiegler MP. A smartphone-based decision support tool improves test performance concerning application of the guidelines for managing regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy. Anesthesiology. 2016;124(1):186-198. doi: 10.1097/ALN.0000000000000885
  9. Epidural and Spinal Anesthesia Decision Aid (PDF).Last accessed December 10, 2019.
  10. Peripheral Nerve Block Decision Aid (PDF). Last accessed December 10, 2019.
  11. Anesthesia 101. Made For This Moment… Physician Anesthesiologists Save Lives® website. Last accessed January 4, 2019.
  12. Pain Management. Made For This Moment… Physician Anesthesiologists Save Lives® website. Last accessed January 4, 2019.
  13. Preparing for Surgery. Made For This Moment… Physician Anesthesiologists Save Lives® website. Last accessed January 4, 2019.
  14. Resources. Made For This Moment… Physician Anesthesiologists Save Lives® website. Last accessed January 4, 2019.
  15. Southerland WA, Tollinche LE, Shapiro FE. Decision aids: the role of the patient in perioperative safety. Int Anesthesiol Clin. 2019;57(3):4-11. 

 

Curated by: ASA Committee on Patient Safety and Education

Date of last update: May 5, 2020