Article
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“)?
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Published: | June 26, 2020 |
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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.