Pilot Study of a Patient Decision Aid for Valve Choices in Surgical Aortic Valve Replacement

Objective superiority of tissue vs mechanical prostheses in surgical aortic valve replacement remains controversial, placing a greater emphasis on patients to consider personal lifestyle and risk preferences, including the burden of lifelong anticoagulation and the possible need for reoperation. A shared decision-making tool may therefore be of value in making this important choice.

A patient decision aid (PtDA) was developed using the International Patient Decision Aids Standards and used in a prospective pilot study. An intervention group received the PtDA and a survey. A control group received the same survey without a PtDA. The survey assessed patients' knowledge, treatment preferences, stage of decision-making, and decisional conflict. Both groups received these materials in the mail before their preoperative consultation for surgical aortic valve replacement. Survey results were compared between the 2 groups.

Response rates were 13 of 17 (76%) and 10 of 18 (56%) for the control and intervention groups, respectively. Patients in the intervention group who reported reviewing the PtDA (n = 6) demonstrated significantly higher knowledge scores (median 100% vs 25%, P = .02) and were able to produce more accurate risk estimates (median 62.5% vs 0%, P = .01). These patients also had less decisional conflict, with median SURE scores (Sure of myself; Understand information; Risk-benefit ratio; Encouragement) of 4 vs 0 P = .04). Stage of decision-making, concern about risk,s and treatment preferences were similar CONCLUSIONS: Use of a PtDA for selection of valve type in surgical aortic valve replacement may improve patient understanding and decisional conflict. Revision of our tool and further studies are warranted to validate these findings in a large cohort of patients.