Understanding Patient Preferences for Surgical Management in the Setting of Cirrhosis: A Mixed-Methods Approach

PROJECT SUMMARY Patients magnitude this Risk created preferences understand that adverse importance understanding and study decision-making undergo repair. where surgery obtain will considering with and 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. s s