Effect of patient decision aids on choice between sugammadex and neostigmine in surgeries under general anesthesia: a multicenter randomized controlled trial

Background: Shared decision-making using patient decision aids (PtDAs) has been established for more than a decade, but few studies have evaluated its efficacy in Asian countries. We evaluated the application of PtDAs in a decision conflict between two muscle relaxant reversal agents— neostigmine and sugammadex—and performed sequential analysis for hospital location and operating room turnover rate. Methods: This two-group, outcome assessor–blind, randomized controlled trial included 3132 surgical patients from two medical centres, admitted between March 2020 and August 2020. The patients were randomly divided into classical explanation and PtDAs-assisted explanation groups in preanesthesia consultations. Their clinicodemographic characteristics were analysed to identify the variables influencing their choice of reversal agent. On the day of preanesthesia consultations, the patients’ decision-making difficulties were assessed using a four-item SURE scale. The operating turnover rate were evaluated according to the anesthesia records. Results: Compared with the classical group, the patients in the PtDAs group felt more confident about receiving sufficient medical information (P < 0.001), were better informed about advantages and disadvantages of the medications (P < 0.001), had superior understanding of benefits and risk of their options (P < 0.001), and had a firm attitude toward their choices (P < 0.001). Moreover, the PtDAs group had a significantly greater tendency to choose sugammadex over neostigmine (P < 0.001). Conclusions: PtDAs intervention in preanesthesia consultations provided surgical patients clear knowledge and better support. PtDAs should also be made available in other medical fields to enhance shared clinical decision-making.