Implementing and evaluating shared decision-making before transcatheter aortic valve implantation with a dedicated...

Area of Science:

• Cardiology
• Health Services Research

Background:

• Transcatheter aortic valve implantation (TAVI) is a key alternative to surgical aortic valve replacement for aortic stenosis.
• Shared decision-making (SDM) is crucial for patient-centered care but is often underutilized.
• Informed patient preference is vital when choosing between TAVI, surgery, or conservative management.

Purpose of the Study:

• To implement and evaluate a structured SDM pathway for patients undergoing evaluation for aortic valve stenosis.
• To assess the impact of the SDM pathway on patient satisfaction and decision-making quality.

Main Methods:

• A structured SDM pathway was established, incorporating decision aids and dedicated meetings.
• A custom questionnaire assessed patient satisfaction using a 12-core question Likert scale (1-5).
• Patient responses were compared pre- and post-implementation of the SDM pathway.

Main Results:

• Global patient satisfaction significantly increased post-SDM pathway implementation (mean Likert score 4.46 vs. 3.78, P < 0.001).
• The percentage of positive responses (Likert 4-5) was significantly higher in the post-SDM group (92.6% vs. 66.2%, P < 0.001).
• Negative responses (Likert 1-2) significantly decreased in the post-SDM group (1.6% vs. 22.6%, P < 0.001).

Conclusions:

• The structured SDM pathway effectively facilitates shared decision-making in line with guidelines.
• This model, potentially leveraging digital tools, can be adapted for other treatments and institutions.
• The pathway enhances patient satisfaction and engagement in treatment choices for aortic valve stenosis.