Exiting Surveillance From Abdominal Aortic Aneurysm Screening: The Views of Clinicians, and Men in Surveillance and Their Family Members

Abstract

Background: The NHS Abdominal Aortic Aneurysm (AAA) Screening Programme in England screens men aged 65. Men with small aneurysms enter annual surveillance. The current 'exit strategy' is to leave surveillance after 15 years if the aneurysm remains small.

Objectives: The aim was to explore the views of clinicians, men in surveillance and their family members about exiting surveillance.

Design: A sequential study involving a Clinical Stakeholder Workshop to explore clinicians' views about factors that should be considered in any exit strategy, followed by a qualitative interview study to explore the views of men in surveillance and family members.

Methods: A Clinical Stakeholder Workshop with 15 clinicians in the United Kingdom. Semi-structured interviews with 22 men in surveillance and 5 of their family members from a single regional screening provider. Data were collected from January 2023 to April 2024. Framework Analysis was used.

Results: Clinicians wanted an exit strategy to reduce unnecessary surveillance. They were concerned about the ethics of men attending for surveillance when they were not healthy enough for future treatment. They identified the need for a 'low risk strategy' for men with a low risk of future AAA rupture and a 'poor health strategy' so men could leave surveillance if they became too ill to attend surveillance or for future surgery. Men and their family members were less welcoming of an exit strategy because they valued the reassurance offered by surveillance. They also had an ethical concern about being removed from surveillance based on age. Some men proposed a reduction in the frequency of surveillance as an alternative to exit. Both clinicians and men valued shared decision-making for exit from surveillance, whilst recognising that this needed to occur in the context of limited resources within the NHS screening programme.

Conclusions: Although clinicians and patients had conflicting views about the need for an exit strategy from AAA surveillance, they agreed that shared decision-making was key to any exit strategy.

Patient or public contribution: This paper presents the perspectives of men with experience of abdominal aortic aneurysm (AAA) surveillance, and some of their family members. One member of the research team, who is also a co-author on this paper, is a man who was diagnosed with an AAA. He actively contributed to the design and delivery of the study as co-applicant on the funding grant. He also attended monthly project meetings where decisions were made about how best to conduct the research. We set up a new Patient and Public Involvement (PPI) Panel made up of men who had experienced AAA screening, including four who were diagnosed with AAA. This panel met eight times throughout the project to ensure that the interview invitations and the topic guide were appropriate; to interpret the findings; and to advise on dissemination strategies.

Keywords: abdominal aortic aneurysm; exit from screening; surveillance.