Abstract 4146361: Patients demonstrate hesitancy to participate in cognitive assessments in an international coronary bypass surgery graft (CABG) surgery trial

Introduction: Coronary artery bypass surgery (CABG) is the most common cardiac surgery in adults, yet it is associated with a range of complications including stroke, cognitive impairment, and dementia. Despite the critical importance of cognitive outcomes, cognition remains understudied in CABG surgery trials, and recruitment for cardiac-related cognitive studies faces substantial challenges. Objective: Identify barriers to recruitment in a cognitive auxiliary study in the international Randomized Comparison Of The Clinical Outcome Of Single Vs Multiple Arterial Grafts (ROMA) trial. Methods: Semi-structured interviews were conducted with research staff (n=12) involved in the ROMA trial to explore themes related to recruitment barriers into ROMA:Cognition. The average interview length was approximately 25 minutes. Qualitative data were analyzed using a directed content analysis approach, and inter-rater reliability was assessed with Cohen's kappa score based on the five most frequently applied codes. Results: Twelve participants were recruited, with a mean age of 48 years. Of these, 90% were female, 60% were from North America, and 30% were from Europe. Key themes identified included: (1) misconceptions of cognition as equivalent to psychiatric disorders, (2) gaps in understanding the importance of measuring cognition for a cardiac-related study, (3) distrust in international data sharing practices, and (4) stigma and apprehension surrounding cognitive decline and mental health issues (Table 1). Conclusion: Educational interventions are crucial to improve patient understanding of the importance of cognitive assessments in the context of cardiac surgery. Addressing misconceptions and reducing stigma related to cognitive testing can enhance patient recruitment and engagement in cognitive auxiliary studies. Emphasizing the brain-heart connection and distinguishing cognitive assessment from psychiatric evaluation are essential steps to ensure comprehensive postoperative care and improve outcomes for CABG patients.