gms | German Medical Science

71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

Patients’ decision-making in elective intracranial aneurysma treatment – bias of initial counselling (e.g. “anchoring effect”)?

Die Entscheidungsfindung des Patienten im Rahmen der elektiven zerebralen Aneurysmaversorgung – Befangenheit durch die Erstberatung (z.B. „Anker-Effekt“)?

Meeting Abstract

  • presenting/speaker Sebastian Siller - Klinikum der Ludwig-Maximilians-Universität München, Neurochirurgische Klinik, München, Deutschland
  • Mathias Kunz - Klinikum der Ludwig-Maximilians-Universität München, Neurochirurgische Klinik, München, Deutschland
  • Jun Thorsteinsdottir - Klinikum der Ludwig-Maximilians-Universität München, Neurochirurgische Klinik, München, Deutschland
  • Franziska Dorn - Klinikum der Ludwig-Maximilians-Universität München, Institut für Neuroradiologie, München, Deutschland
  • Thomas Liebig - Klinikum der Ludwig-Maximilians-Universität München, Institut für Neuroradiologie, München, Deutschland
  • Jörg-Christian Tonn - Klinikum der Ludwig-Maximilians-Universität München, Neurochirurgische Klinik, München, Deutschland
  • Christian Schichor - Klinikum der Ludwig-Maximilians-Universität München, Neurochirurgische Klinik, München, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocV273

doi: 10.3205/20dgnc269, urn:nbn:de:0183-20dgnc2691

Published: June 26, 2020

© 2020 Siller et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: Interdisciplinary neurovascular boards (INVB) are deemed to find the optimum treatment modality in elective intracranial aneurysma repair (EIAR) for each individual patient. However, if risk estimation and prospect of therapeutic success are judged similar for microsurgical or interventional EIAR, the treatment decision is made by the patient after secondary counselling by both disciplines. A highly reputed determinant in this context is the so-called "anchoring effect" which describes the phenomenon that initial counselling drives the decision in favour of the first specialist who was contacted before INVB.

Methods: We analysed all patients with EIAR after INVB discussion at our interdisciplinary neurovascular center between 2007–2017 and investigated the patients’ characteristics, imaging/procedural parameters and outcomes and determined if the mode of initial counselling prior to INVB influenced the patients’ choice of EIAR in the above mentioned context.

Results: Altogether 572 patients with EIAR were discussed in our INVB. While in 473 (83%) patients the INVB recommended one superior treatment of choice, in a subset of 99 patients (17%) the INVB recommendation estimated similar treatment risks for both modalities. All these patients received subsequent secondary counselling by specialists of both disciplines. Mean age in this subset was 58.2yrs with a predominance of the female sex (m:f=1:2); the most frequent aneurysm location was ICA (48%) and AcomA (35%) and the median diameter was 5.5mm. 66 patients underwent microsurgical and 33 patients interventional EIAR with no significant differences in baseline characeteristics or outcome parameters at last follow-up (median 18mos). Initial patients’ counselling prior to INVB presentation took place at the neurosurgical department in 80 cases of that 53 (66%) decided for microsurgical EIAR after INVB, while initial patients’ counselling at the neuroradiological department in 19 cases was followed by interventional EIAR in 8 patients (42%). There was no statistical significance indicating a bias in patients’ treatment decision-making due to "anchoring effects".

Conclusion: Initial patients’ counselling in different neurovascular disciplines seems not to influence the final patients’ decision-making for a distinct mode of EIAR. However, we found a preference towards surgical repair after secondary counselling. Outcome measures of both treatment modalities suggest that equal risk estimation by INVB was correct.