Acceptability of a decision aid for the treatment of symptomatic carotid artery disease.

Shared decision-making is now required for reimbursement of carotid artery stenting procedures in standard-risk patients with symptomatic carotid stenosis, yet contemporary decision aids that incorporate all available revascularization options are lacking. We developed and evaluated the acceptability of a modern and comprehensive decision aid for patients with symptomatic carotid stenosis considering revascularization. A multidisciplinary team developed a decision aid describing medical management, carotid endarterectomy, transfemoral carotid artery stenting, and transcarotid artery revascularization using an iterative, user-centered design process. Development was informed by established decision support frameworks and refined through interviews with patients and clinicians. Qualitative feedback was analyzed using a rapid thematic approach. Acceptability and usability were assessed using descriptive survey measures. Nine clinicians and 10 patients participated in qualitative interviews, and 9 clinicians and 35 patients completed acceptability surveys. Feedback informed 41 iterative revisions of the decision aid. Patients and clinicians described the tool as clear, comprehensive, and useful for supporting treatment discussions. Among clinicians, 100% reported that the decision aid was helpful and would recommend its use. Among patients, 82.9% found the decision aid very helpful and 73.5% would definitely recommend it. Most clinicians (90%) and patients (65.7%) perceived the information as balanced across treatment options. An iterative, stakeholder-driven development process produced a decision aid that was highly acceptable to both patients and clinicians. This tool may facilitate shared decision-making for symptomatic carotid stenosis and help address emerging policy requirements for carotid revascularization discussions.