Preoperative Counseling Increases Shared Decision-Making in CRC Surgery

"Using 3D models during consultations allowed our patients to truly visualize their surgery, which not only empowered them to take an active role in decision-making but also significantly eased their anxiety,” according to Aimal Khan, MD, FACS.

Preoperative counseling aided with 3-dimensional (3D)–printed models improved shared decision-making (SDM) among a small cohort of patients undergoing surgery for colorectal cancer (CRC), according to findings from a single-center cluster clinical trial (NCT06625008) published in JAMA Network Open.¹

Data from the trial revealed that patients in the 3D-printed model arm had significantly higher scores in the 9-item Shared Decision Making Questionnaire (SDM-Q-9) survey vs those who received conventional care, with mean scores of 89.5 (SD, 17.6) and 80.5 (SD, 14.4), respectively (P = .01). Additionally, after dichotomizing for health literacy, a similar trend was observed among patients with a Brief Health Literacy Screening Tool (BRIEF) score of 17 or higher, indicating higher health literacy, vs those with scores lower than 17. The mean SDM-Q-9 survey scores in the 17 or higher cohort were 94.1 (SD, 9.4) among those who received 3D-printed model counseling and 81.9 (SD, 15.6) among those who underwent standard counseling (P = .01).

Furthermore, postintervention anxiety score decreases favored the investigational arm vs the standard-of-care arm. Although anxiety scores decreased in both arms, from 50.4 (SD, 18.3) to 48.0 (SD, 15.3) in the conventional care arm vs 53.5 (SD, 21.2) to 44.1 (SD, 15.8) in the investigational arm, the decrease in anxiety scores was more pronounced in the 3D-printed model arm (P = .04). However, a clinically significant difference was not seen, as the minimal clinically important difference (MCID) threshold of 10 points was not observed for the total population or when dichotomized by health literacy.

“Using 3D models during consultations allowed our patients to truly visualize their surgery, which not only empowered them to take an active role in decision-making but also significantly eased their anxiety,” Aimal Khan, MD, FACS, assistant professor of surgery at Vanderbilt University Medical Center, said in a news release on the study findings.² “This approach has the potential to transform how we communicate complex information to our patients. We are currently working with surgeons from other specialties, including thoracic surgery, [head and neck], and surgical oncology, to validate these findings in a multicenter randomized trial.”

Patients 18 years or older scheduled for partial or complete resection of the colon and/or rectum for CRC, diverticular disease, or inflammatory bowel disease at Vanderbilt University Medical Center from March 2022 to June 2023 were randomly assigned to receive 3D-printed model counseling (n = 28) or usual care (n = 23). Additionally, each arm was randomly assigned 3 surgeons to conduct preoperative patient education using the 3D-printed model or routine care consisting of surgeon-drawn or preprinted images, patient scans, and verbal explanations of disease and treatment options.

Patients enrolled were assessed for health literacy prior to the intervention and were evaluated for knowledge of disease and anxiety levels before and after the intervention. Additionally, their perceived involvement in the decision-making process was evaluated once after the intervention.

Among patients who were assigned to the 3D model intervention vs routine care, the mean age was 47.7 (SD, 14.3) vs 55.3 (SD, 14.0) years in the respective groups. A total of 50.0% vs 60.9% of each arm were female, 85.7% vs 87.0% were White, and 67.9% vs 56.5% had a BRIEF score of 17 or greater.

The primary end point of the study was patient-perceived SDM. Secondary end points included the impact of the intervention on patient anxiety and knowledge vs usual care.

Although patients in both arms saw improvements in the overall Patient Education Assessment Questionnaire scores, no significant difference between the 2 arms emerged after adjusting for baseline scores. Furthermore, significant improvements in understanding the locations of disease and resection sites were observed across both arms.

References

1. Khan A, Sellyn GE, Ali D, et al. Three-dimensional–printed models and shared decision-making: a cluster randomized clinical trial. JAMA Netw Open. 2025;8(6):e2513187. doi:10.1001/jamanetworkopen.2025.13187
2. Wilemon T. Presurgery consults with patients using 3D models improve shared decision-making and reduce anxiety. Vanderbilt University Medical Center. June 9, 2025. Accessed June 11, 2025. https://tinyurl.com/yw35f2dp