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Multicenter Study
. 2025 Oct:248:116415.
doi: 10.1016/j.amjsurg.2025.116415. Epub 2025 May 16.

High usability, low adoption: The struggle of a perioperative patient decision aid for extended thromboprophylaxis after major abdominal cancer surgery

Victoria Ivankovic  1 , Abdelrahman Noureldin  2 , Celine Dainhi  3 , Mary Farnand  4 , Rebecca C Auer  5 , Sameer Apte  5 , Lev Bubis  6 , Pamela Hebbard  7 , Justin Rivard  7 , Marc Carrier  8 , Megan Delisle  9
Affiliations
Multicenter Study

High usability, low adoption: The struggle of a perioperative patient decision aid for extended thromboprophylaxis after major abdominal cancer surgery

Victoria Ivankovic et al. Am J Surg. 2025 Oct.

Abstract

Background: Clinical guidelines recommend 30-day extended venous thromboembolism (VTE) prophylaxis after major abdominal cancer surgery, though equipoise exists among experts. We developed a patient decision aid (PtDA) to support patient decision-making and evaluated its perioperative usability.

Methods: Patients undergoing major abdominal cancer surgery and discharging healthcare professionals at two academic centers were recruited. Usability was assessed using the Post Study System Usability Questionnaire (PSSUQ) for patients and the Pragmatic Assessment Tool (pCAT) for clinicians. PtDA revisions occurred iteratively every three participants.

Results: Of 108 eligible patients, 79 (73%) enrolled, and 20 (25%) completed the PtDA. Among them, 65% used it to decide on extended VTE prophylaxis. The median PSSUQ score was 2 (IQR 2-3.75). Fifteen clinicians completed the pCAT, reporting more facilitators than barriers to its implementation.

Conclusion: The PtDA was highly useable, but low completion rates suggest systemic barriers that require further study to improve implementation.

Keywords: Perioperative decision-making; Shared decision making; Usability; Venous thromboembolism.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Victoria Ivankovic reports financial support was provided by Ontario association of general surgeons. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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