PROJECT
SUMMARY
Patients
magnitude
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Risk
created
preferences
understand
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importance
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and
study
decision-making
undergo
repair.
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surgery
obtain
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with cirrhosis have a higher surgical risk as compared to patients without cirrhosis and estimating the
of risk is challenging i n clinical practice. Several risk prediction tools have been created to assist with
process and with prognostic discussions, including the recently developed VOCAL-Penn Cirrhosis Surgical
Score. However, all prediction scores focus heavily on post-operative mortality as an outcome, and all were
with the provider perspective in mind. To date there have been no tudies exploring the perspective and
of patients with cirrhosis when deciding to pursue or avoid a given surgical procedure. Failure to
and incorporate this perspective into prognostic discussions reflects a paternalistic medical approach
may lead to patient regret, patient dissatisfaction, and reduced post-operative quality of life, among other
outcomes. Through a mixed-methods approach, we hypothesize that identifying and quantifying the
of patient-important surgical outcomes in patients with cirrhosis will lead to a more comprehensive
of the patient perspective that will translate to improved shared decision-making between patients
providers. The primary aims of this proposal are as follows: in Specific Aim 1 , we will perform a qualitative
of diverse patients with cirrhosis to elicit characteristics and outcomes of surgery that are important in
( attributes ) and explore how changing the levels of these attributes may change willingness to
surgery. This will be applied to a specific, common surgical scenario: an elective abdominal hernia
In Specific Aim 2 , the data from the prior aim will be used to create a discrete choice experimental survey
patients with cirrhosis are asked to evaluate scenarios with mutually exclusive options to proceed with
or non-surgical management for a symptomatic abdominal hernia. By varying levels of attributes, we will
critical i nformation regarding tradeoffs that patients are willing to make in different surgical scenarios. This
result in a quantitative, hierarchical understanding of attributes that patients consider to be important when
this urgery, which will provide a new framework for clinicians to approach prognostic discussions
patients. By aligning patient and provider expectations, this project will facilitate shared decision-making
support patient autonomy, which are key principles of medical ethics.
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