Acceptability among patients of a risk graphic designed to facilitate shared decision making prior to elective abdominal wall hernia repair

TL;DR

This study explores how patients perceive a risk graphic tool designed to help them understand and discuss surgical risks before abdominal wall hernia repair.

Contribution

The study introduces a novel approach to shared decision-making by involving patients in evaluating a dynamic risk visualization tool.

Findings

Participants agreed the risk graphic improved their understanding of risk and behavior change opportunities.

The tool was seen as valuable for sparking conversations with surgeons and supporting shared decision-making.

Areas for improvement in the graphic's design were identified through patient feedback.

Abstract

Risk calculators for elective surgery rarely engage patients in designing dynamic visual imagery illustrating how risk can change with preoperative optimization. We conducted a mixed methods study examining the acceptability of illustrated components of a risk calculator for elective hernia repair with patients.

We conducted semi-structured interviews between August and September 2024. Participants were guided through the visual components of an abdominal wall hernia repair risk calculator and asked to “think aloud” while providing feedback on the tool’s visual appearance. Participants completed a validated scale identifying characteristics for intervention improvement. Quantitative analyses were performed using descriptive statistics, while qualitative data were analyzed using inductive framework analysis.

26 participants completed interviews. Mean age was 49.3 (SD 14.21), mean BMI was 27.8 (SD 6.64). 57.6% identified as female sex, 80.8% identified as White or Caucasian, 11.6% Black or African American, and 3.8% as Hispanic/Latino. 23.1% identified as smokers. Participants agreed that the risk graphic improved their ability to understand risk and behavior change opportunities with a mean agreement of 3.96 (SD 1.31) on a 1–5 agreement scale. Participants noted how clear the graphic was in improving their ability to discuss behavior change opportunities with their surgeon prior to their operation with a mean agreement of 4.04 (SD 1.22) on a 1–5 agreement scale. Qualitatively, we identified four major domains: 1) Delivery Method of the Tool; 2) Usability of the Tool; 3) Interpreting Risk from the Tool; and 4) Value of the Tool. Participants felt the tool sparked conversations with the surgeon, was accessible for shared decision-making, and highlighted the importance of contextualizing risk in decision-making.

Interviews identified areas of improvement for the risk graphic’s visual design and provided signals for how the graphic can be implemented clinically. This study emphasized the importance of incorporating patient perspectives into tools designed for shared decision-making.

The online version contains supplementary material available at 10.1007/s00464-025-12217-y.

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