Men’s preferences for exiting abdominal aortic aneurysm surveillance: a deliberative engagement session study

The national screening programme guidance for Abdominal Aortic Aneurysm (AAA) in England states that men with small AAAs will exit surveillance after 15 years. This study explored the informed preferences of men for AAA surveillance. A Deliberative Engagement Session was conducted in two workshops comprising 30 men in AAA surveillance and six of their family members. The workshops consisted of measurement of men’s knowledge and preferences pre- and post-deliberation, presentations by experts, and deliberation by men and their family members, in terms of knowledge sharing and discussion. Before deliberation, only two of the 30 men in the session were aware of the existence of an exit strategy from AAA surveillance, and their knowledge levels about AAA were poor. Post-deliberation, knowledge levels increased from a median score of 6 (IQR 4 to 7) to a median score of 8 (IQR 8 to 9) correct answers to 11 multiple-choice questions about AAA and AAA screening (p < 0.001). Men in the session identified rate of growth of AAA, size of AAA, health issues that may make surgery risky, and the views of healthcare professionals as important factors to consider in any exit strategy. Most men in the session preferred a strategy whereby they were not discharged from surveillance but had longer intervals between scans (two yearly rather than yearly). Discussion revealed the importance to men and family members of the reassurance surveillance offered to them. In terms of how decisions should be made regarding exit, men in this session wanted to have estimates of the risks of different options, to discuss exit with a Nurse Specialist, and that the patient should decide. Based on informed preferences, men in this Deliberative Engagement Session preferred longer intervals between scans rather than exiting surveillance because of the reassurance offered by surveillance.