European heart journal open · 2024
Implementing and evaluating shared decision-making before transcatheter aortic valve implantation with a dedicated pathway and questionnaire.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
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Carulli Ermes, Browne Suzy, Woolley Sara, Tindale Alexander, Pottle Alison, Nagle Kate, Lane Rebecca, Chandra Navin, Patel Niket, De Palma Rodney, Barnes Gareth, Kabir Tito, Panoulas Vasileios, Smith David, Smith Robert, Clernon Sharon, Heng Ee Ling, Akhtar Mohammed, Bowers Mark, McGovern Ian, Lüscher Thomas, Dalby Miles
Аннотация
AIMS: Transcatheter aortic valve implantation (TAVI) is an alternative to surgical aortic valve replacement for patients with aortic valve stenosis. The choice between TAVI, surgery, or a conservative approach should be based upon multiple factors including clinical considerations, technical feasibility, and informed patient preference. In this context, engaging patients in a shared decision-making (SDM) process becomes essential, but this practice is generally underused.
METHODS AND RESULTS: To comply with the European and UK national guidelines, in January 2023 we established a structured SDM pathway in which patients are offered virtual/physical decision aids and after 1 week are invited to a meeting to reach a shared decision. From December 2022 to June 2023, a custom-developed questionnaire was prospectively administered to 23 patients prior to, and 38 patients after, the implementation of the SDM pathway. The answers to 12 core questions were recorded on a Likert scale (1-5). Global satisfaction, as measured by mean Likert score, was significantly higher for the post-SDM group than for the pre-SDM group (4.46 ± 0.14 vs. 3.78 ± 0.30, P < 0.001). The percentage of positive (Likert 4-5) responses was significantly higher in the post-SDM group (289/312, 92.6% vs. 155/234, 66.2%, P < 0.001). The percentage of negative (Likert 1-2) responses was significantly lower in the post-SDM group (5/312, 1.6% vs. 53/234, 22.6%, P < 0.001).
CONCLUSION: The SDM pathway proved effective in delivering SDM in compliance with national and international guidance. A similar approach leveraging digital technology to minimize cost and enhance patient convenience could be implemented for other treatments and across other institutions.
METHODS AND RESULTS: To comply with the European and UK national guidelines, in January 2023 we established a structured SDM pathway in which patients are offered virtual/physical decision aids and after 1 week are invited to a meeting to reach a shared decision. From December 2022 to June 2023, a custom-developed questionnaire was prospectively administered to 23 patients prior to, and 38 patients after, the implementation of the SDM pathway. The answers to 12 core questions were recorded on a Likert scale (1-5). Global satisfaction, as measured by mean Likert score, was significantly higher for the post-SDM group than for the pre-SDM group (4.46 ± 0.14 vs. 3.78 ± 0.30, P < 0.001). The percentage of positive (Likert 4-5) responses was significantly higher in the post-SDM group (289/312, 92.6% vs. 155/234, 66.2%, P < 0.001). The percentage of negative (Likert 1-2) responses was significantly lower in the post-SDM group (5/312, 1.6% vs. 53/234, 22.6%, P < 0.001).
CONCLUSION: The SDM pathway proved effective in delivering SDM in compliance with national and international guidance. A similar approach leveraging digital technology to minimize cost and enhance patient convenience could be implemented for other treatments and across other institutions.