Improving shared decision-making and risk communication in vascular surgery

Shared decision-making (SDM) is the concept of involving both healthcare professionals and patients in incorporating the patient’s preferences into the final treatment decision in order to improve quality of care. Vascular surgical patients may especially benefit from SDM as there is usually more than one treatment option available and treatment decisions can be highly preference-sensitive. Therefore, it is important for vascular surgeons to understand the concerns and treatment goals of their patients. As this may very well affect whether non-surgical treatment is continued, endovascular treatment or a more invasive open surgical treatment is performed. For example, patients with an abdominal aortic aneurysm face multiple concerns when deciding between endovascular aortic aneurysm repair (EVAR) and open surgical repair. One of these concerns entails the need for follow-up after EVAR. Patients who undergo EVAR are required to undergo lifelong yearly imaging surveillance, since 22% of patients develop complications that will require one or more reinterventions. Unfortunately, yearly imaging surveillance with computed tomography may also harm patients by risking contrast-nephropathy and an increased attributable lifetime cancer risk. The first part of this thesis focusses on ways to measure and improve SDM in vascular surgery. For example by the development of different decision support tools. The second part of this thesis focusses on ways to improve risk communication with vascular surgical patients, which is a key aspect of SDM. The third part of this thesis focusses on the benefits and harms of yearly imaging surveillance following EVAR

Improving shared decision-making and risk communication in vascular surgery

Shared decision-making (SDM) is the concept of involving both healthcare professionals and patients in incorporating the patient’s preferences into the final treatment decision in order to improve quality of care. Vascular surgical patients may especially benefit from SDM as there is usually more than one treatment option available and treatment decisions can be highly preference-sensitive. Therefore, it is important for vascular surgeons to understand the concerns and treatment goals of their patients. As this may very well affect whether non-surgical treatment is continued, endovascular treatment or a more invasive open surgical treatment is performed. For example, patients with an abdominal aortic aneurysm face multiple concerns when deciding between endovascular aortic aneurysm repair (EVAR) and open surgical repair. One of these concerns entails the need for follow-up after EVAR. Patients who undergo EVAR are required to undergo lifelong yearly imaging surveillance, since 22% of patients develop complications that will require one or more reinterventions. Unfortunately, yearly imaging surveillance with computed tomography may also harm patients by risking contrast-nephropathy and an increased attributable lifetime cancer risk. The first part of this thesis focusses on ways to measure and improve SDM in vascular surgery. For example by the development of different decision support tools. The second part of this thesis focusses on ways to improve risk communication with vascular surgical patients, which is a key aspect of SDM. The third part of this thesis focusses on the benefits and harms of yearly imaging surveillance following EVAR

Benchmarking recent national practice in rectal cancer treatment with landmark randomized controlled trials

Contains fulltext : 175601.pdf (publisher's version ) (Closed access

Cross-Sectional Study on MRI Restaging After Chemoradiotherapy and Interval to Surgery in Rectal Cancer: Influence on Short- and Long-Term Outcomes

Background. The time interval between CRT and surgery in rectal cancer patients is still the subject of debate. The aim of this study was to first evaluate the nationwide use of restaging magnetic resonance imaging (MRI) and its impact on timing of surgery, and, second, to evaluate the impact of timing of surgery after chemoradiotherapy (CRT) on short- and long-term outcomes.Methods. Patients were selected from a collaborative rectal cancer research project including 71 Dutch centres, and were subdivided into two groups according to time interval from the start of preoperative CRT to surgery (= 14 weeks), and the long-interval group included a higher proportion of cT4 stage and multivisceral resection patients. Pathological complete response rate (n = 34 [15.2%] vs. n = 47 [18.7%], p = 0.305) and CRM involvement (9.7% vs. 15.9%, p = 0.145) did not significantly differ. Thirty-day surgical complications were similar (20.1% vs. 23.1%, p = 0.943), however no significant differences were found for local and distant recurrence rates, disease-free survival, and overall survival.Conclusions. These real-life data, reflecting routine daily practice in The Netherlands, showed substantial variability in the use and timing of restaging MRI after preoperative CRT for rectal cancer, as well as time interval to surgery. Surgery before or after 14 weeks from the start of CRT resulted in similar short- and long-term outcomes.Surgical oncolog