Reasons Underlying the Consent to Endovascular Treatment, Displayed by Patients Diagnosed with Asymptomatic Internal Carotid Artery Stenosis
Michał-Goran Stanišić, Teresa Rzepa
Department of General and Vascular Surgery, Poznań University of Medical Sciences, Poznań, Poland
Med Sci Monit 2014; 20:1503-1509
Endovascular treatment of internal carotid artery stenosis (ICAS) has gained popularity in recent years. Offering CAS, which is a controversial treatment in asymptomatic disease, may provoke patient distrust of the diagnosis and intervention benefit.
The aim of this study was to prove that asymptomatic ICAS patients tend to show an emotional attitude to their illness, and therefore their decisions regarding carotid artery stenting are externally motivated and assessed emotionally.
Material and Methods: This study was conducted by a questionnaire consisting of 18 half-open questions (obtained from 25 consecutive patients) in categories of self-image, attitude to illness, and decision-making regarding CAS. Descriptive analysis was performed.
Results: Reaction: “Nothing to worry about – every illness can be cured” evidenced the rational attitude to the disease. Attitude towards oneself after receiving the unexpected information about the disease did not change. Most patients pursued a second opinion before the intervention.
Most patients showed internal motivation (78.7%). Rational assessment of the decision on CAS relied on consulting and insights into the disease and the intervention-related risk compared to risk of “doing nothing”
Conclusions: In decision-making about CAS by asymptomatic patients, the emotional attitude to disease and negative expectations pertaining to postoperative health lead to an internally-motivated and rationally assessed decision.
At least 2 conversations with the patient should be scheduled. The primary purpose of the second visit should be dissipating any doubts and repeating the arguments for the intervention. Patients should be provided with an appropriate amount of information to reduce their fear of neurological complications and mental disturbances. Conversation should be concentrated on life-quality improvement instead of controversies about the intervention.
Keywords: Carotid Artery, Internal - surgery, Carotid Stenosis - surgery, Decision Making, Emotions, Endarterectomy, Carotid - psychology, Health Knowledge, Attitudes, Practice