An iterative, stakeholder-driven development process produced a decision aid for symptomatic carotid stenosis that was highly acceptable to both patients and clinicians, and may facilitate shared decision-making and help address emerging policy requirements for carotid revascularization discussions.
Key Findings
Methods
A multidisciplinary team developed a decision aid for symptomatic carotid stenosis through an iterative, user-centered design process that incorporated feedback from both patients and clinicians.
The decision aid described four treatment options: medical management, carotid endarterectomy, transfemoral carotid artery stenting, and transcarotid artery revascularization.
Development was informed by established decision support frameworks.
Nine clinicians and 10 patients participated in qualitative interviews to refine the tool.
Qualitative feedback was analyzed using a rapid thematic approach.
Feedback from interviews informed 41 iterative revisions of the decision aid.
Results
Clinician acceptability of the decision aid was very high, with all clinicians reporting the tool was helpful and recommending its use.
Nine clinicians completed acceptability surveys.
100% of clinicians reported that the decision aid was helpful.
100% of clinicians said they would recommend its use.
90% of clinicians perceived the information as balanced across treatment options.
Clinicians described the tool as clear, comprehensive, and useful for supporting treatment discussions.
Results
Patient acceptability of the decision aid was high, with a majority finding it very helpful and willing to recommend it.
35 patients completed acceptability surveys.
82.9% of patients found the decision aid very helpful.
73.5% of patients would definitely recommend it.
65.7% of patients perceived the information as balanced across treatment options.
Patients described the tool as clear, comprehensive, and useful for supporting treatment discussions.
Background
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 incorporating all available revascularization options were lacking prior to this study.
The policy requirement for shared decision-making applies to carotid artery stenting in standard-risk patients with symptomatic carotid stenosis.
The authors identified a gap in contemporary decision aids that incorporate all available revascularization options.
The developed tool was described as addressing 'emerging policy requirements for carotid revascularization discussions.'
The decision aid includes transcarotid artery revascularization (TCAR), a relatively newer option not included in older decision aids.
Results
Patients and clinicians described the decision aid as clear, comprehensive, and useful for supporting treatment discussions across qualitative interviews.
Nine clinicians and 10 patients participated in qualitative interviews.
Thematic findings included perceptions of clarity, comprehensiveness, and utility.
Qualitative feedback directly drove iterative revisions, with 41 total revisions made to the decision aid.
The rapid thematic approach was used to analyze qualitative feedback.
What This Means
This research describes the development and testing of a patient decision aid — an educational tool designed to help patients understand their treatment options — for people diagnosed with symptomatic carotid artery disease, a condition where a narrowed neck artery has already caused stroke-like symptoms. The tool covers four treatment choices: medication alone, traditional surgery (carotid endarterectomy), a catheter-based procedure through the groin (transfemoral carotid artery stenting), and a newer catheter-based procedure through the neck (transcarotid artery revascularization or TCAR). The research team used an iterative, user-centered design process, gathering feedback from both patients and clinicians across multiple rounds of revision, ultimately making 41 changes to the tool before finalizing it.
The study found that the decision aid was well-received by both groups. All clinicians (100%) said it was helpful and would recommend it, while about 83% of patients found it very helpful and about 74% said they would definitely recommend it to others. Both patients and clinicians described the tool as clear, comprehensive, and useful for guiding treatment conversations. A majority in both groups also felt the information was presented in a balanced way across all treatment options.
This research matters because new policy requirements now mandate shared decision-making conversations before carotid artery stenting can be reimbursed in certain patients, yet up-to-date tools to support these conversations — particularly ones including newer procedures like TCAR — were not previously available. This research suggests that a carefully developed, stakeholder-informed decision aid can fill that gap and be acceptable to the people who would use it, potentially improving the quality of treatment discussions between patients and their care teams.
Eklund K, Wallace B, Columbo J, Krafcik B, Fullard M, Matlock D, et al.. (2026). Acceptability of a decision aid for the treatment of symptomatic carotid artery disease.. Seminars in vascular surgery. https://doi.org/10.1053/j.semvascsurg.2026.07.010