Informing Patients About Their Surgery's Environmental Impact: an Effective Pathway to Sustainable Healthcare?

The healthcare sector contributes significantly to climate change. Reducing the number of patients receiving resource-intensive procedures such as surgery can lower carbon emissions, particularly when two treatments with comparable clinical outcomes are available. Nevertheless, the impact of incorporating environmental considerations into patients' decision-making processes remains underexplored. The investigators examine how including information about the environmental impact of treatment options in a gallstone decision aid affects patients' real-life choice between surgery and the more sustainable alternative of conservative treatment. Moreover, the investigators examine whether factors such as severity of symptoms moderate the relation between sustainability information and patients' treatment choice. An exploratory vignette study informed the hypotheses that will be tested among actual patients with gallstones making actual treatment decisions. The results of this ecologically valid study have implications for both clinical practice and healthcare policy by offering insight into the effectiveness of pathways to include patients in the transition towards sustainable healthcare.

Study Overview

• Status: Not yet recruiting
• Conditions: Decision Aid; Gallstone; Sustainability; Decision Making ,Shared
• Intervention / Treatment: Behavioral: Sustainability added to decision aid

• Study Type: Interventional
• Enrollment (Estimated): 400
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Monique Chambon, PhD; Phone Number: +31 (0)20 525 5340; Email: m.chambon@uva.nl

Study Locations

• Netherlands
  • North Holland
    • Amsterdam, North Holland, Netherlands
      • University of Amsterdam

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Patients who were referred to three participating hospitals located across the Netherlands
• Patients who received PatientPlus' gallstone decision aid in preparation for their surgical consultation

Exclusion Criteria:

• None

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Intervention condition; Intervention condition, in which a decision aid includes a page with information about the environmental impact of surgical removal of the gallbladder.	Behavioral: Sustainability added to decision aid; The intervention decision aid includes a page with information about the environmental impact of surgical removal of the gallbladder, and a control condition, which includes no such information. Besides information about the environmental impact of gallbladder surgery, the intervention and control conditions will be identical. At the end of the decision aid patients will be debriefed in general phrasing (i.e., the aim of this study was to examine which factors affect treatment choice) to prevent influencing the actual decision. Approximately three months after patients received the decision aid, patients will receive an invitation via the PatientPlus portal to complete a survey in which the investigators inquire about their final treatment decision (first reminder after one week, second reminder after two weeks). At the end of this survey, patients will be debriefed about the aim of examining how information about the environmental impact of surgery affects treatment choice.
No Intervention: Control condition; A control condition, which includes no information on sustainability in the decision aid.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Treatment preference (surgery or wait-and-see)	The primary outcome is treatment preference. Specifically, participants will indicate their treatment preference by selecting either the option 'Surgery' or 'Wait and see' (dichotomous variable)	baseline, pre-intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Treatment certainty	Combination of treatment preference and certainty. Treatment certainty will be determined by answering the question 'How sure are you about what you want?' on a scale from 1 (Very uncertain) to 10 (Very certain). Treatment preference*certainty will be calculated after data collection by multiplying treatment preference (coded as 1 for surgery and -1 for wait and see thus no surgery) with treatment certainty, resulting in a scale from -10 (Very certain about choosing no surgery) to +10 (Very certain about choosing surgery). Adding this continuous measure allows for capturing more nuanced differences between the intervention and control conditions compared to dichotomous measures.	baseline, pre-intervention
Treatment decision	Secondary outcome is treatment decision (number of patients that choose surgery and number of patients that choose wait-and-see)	Assessment 3 months after the participants receive the decision aid

Collaborators and Investigators

• Sponsor: University of Amsterdam
• Collaborators: Radboud University Medical Center; Leiden University Medical Center

Study record dates

Study Major Dates

• Study Start (Estimated): April 1, 2026
• Primary Completion (Estimated): April 1, 2027
• Study Completion (Estimated): July 1, 2027

Study Registration Dates

• First Submitted: March 20, 2026
• First Submitted That Met QC Criteria: March 25, 2026
• First Posted (Actual): April 1, 2026

Study Record Updates

• Last Update Posted (Actual): April 1, 2026
• Last Update Submitted That Met QC Criteria: March 25, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Calculi; Pathological Conditions, Anatomical; Digestive System Diseases; Biliary Tract Diseases; Gallbladder Diseases; Cholelithiasis; Cholecystolithiasis; Pathological Conditions, Signs and Symptoms; Gallstones
• Other Study ID Numbers: UvA-FMG-12737; KICH1.MV02.22.017 (Other Grant/Funding Number: Dutch Research Council (NWO) for the CAREFREE consortium)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No