Abstract WP164: The Rapid and Rigorous Development of a Patient Decision Aid for Carotid Artery Stenosis

Introduction: Shared decision-making (SDM) is an evidence-based approach that empowers patients to make informed, values-congruent medical choices. The recent Medicare National Coverage Determination for carotid artery stenting expands patient coverage and mandates documentation of a formal SDM interaction for reimbursement purposes. However, no validated patient decision aids (PtDAs) that include all contemporary carotid revascularization options are in widespread use. The study aimed to rapidly and rigorously develop a comprehensive and acceptable PtDA for symptomatic carotid artery disease. Methods: Semi-structured interviews were conducted with key stakeholders, including clinicians and patients with a history of symptomatic carotid stenosis who had undergone revascularization within the past two years. The PtDA was iteratively refined based on end-user feedback. Qualitative data were analyzed using content analysis. Quantitative results on usability, acceptability, feasibility, and bias were analyzed using descriptive statistics. Results: In addition to panel-based feedback from patients and cardiovascular outcomes researchers, 11 clinicians (Table 1) and 9 patients (Table 2) participated in interviews across 34 iterative revisions of the PtDA (Figure 1). Participants found the PtDA educational, comprehensive, balanced, and acceptable. Clinicians highlighted its utility as an accurate framework to guide a SDM interaction for carotid revascularization, while also noting implementation barriers such as divergent stakeholder opinions on preferred procedures, a lack of choice for some patients due to anatomy or comorbidities, and unequal evidence quality for procedural options. Patients universally reported they would have valued the PtDA at the time of their decision and shared that trust in their medical team helped resolve decisional uncertainty. Quantitatively, 89% of clinicians rated the PtDA as balanced and clear; all found it at least somewhat helpful and would recommend it. Among patients, 60% perceived the PtDA as balanced; all found it clear and very helpful and would recommend it. Conclusions: Using a rapid and iterative design, we successfully created a comprehensive, accurate, and balanced PtDA for symptomatic carotid stenosis. Future work will validate the tool in real-world settings among patients with symptomatic carotid stenosis facing a revascularization decision and extend development to a parallel PtDA for asymptomatic carotid disease.