Professionals’ views on shared decision-making in severe aortic stenosis

Abstract

ObjectiveTo provide insight into professionals’ perceptions of and experiences with shared decision-making (SDM) in the treatment of symptomatic patients with severe aortic stenosis (AS).MethodsA semistructured interview study was performed in the heart centres of academic and large teaching hospitals in the Netherlands between June and December 2020. Cardiothoracic surgeons, interventional cardiologists, nurse practitioners and physician assistants (n=21) involved in the decision-making process for treatment of severe AS were interviewed. An inductive thematic analysis was used to identify, analyse and report patterns in the data.ResultsFour primary themes were generated: (1) the concept of SDM, (2) knowledge, (3) communication and interaction, and (4) implementation of SDM. Not all respondents considered patient participation as an element of SDM. They experienced a discrepancy between patients’ wishes and treatment options. Respondents explained that not knowing patient preferences for health improvement hinders SDM and complicating patient characteristics for patient participation were perceived. A shared responsibility for improving SDM was suggested for patients and all professionals involved in the decision-making process for severe AS.ConclusionsProfessionals struggle to make highly complex treatment decisions part of SDM and to embed patients’ expectations of treatment and patients’ preferences. Additionally, organisational constraints complicate the SDM process. To ensure sustainable high-quality care, professionals should increase their awareness of patient participation in SDM, and collaboration in the pathway for decision-making in severe AS is required to support the documentation and availability of information according to the principles of SDM.

Roles and competencies of nurses and physicians in shared decision‐making in cardiac surgery: A scoping review

“…Most studies (Heggland & Hausken, 2014; Kannan et al, 2020; Keij et al, 2021; Skaar et al, 2017; van Beek‐Peeters et al, 2022; Zeuner et al, 2015) ( n = 6) were qualitative research studies except two (Driever et al, 2020; Gualano et al, 2019) that used a cross‐sectional design. The authors of the eight selected articles came from four different countries (Netherlands ( n = 3), Norway ( n = 2), United States of America ( n = 2) and Italy ( n = 1)).…”

“…The authors of the eight selected articles came from four different countries (Netherlands ( n = 3), Norway ( n = 2), United States of America ( n = 2) and Italy ( n = 1)). The roles and competencies required to practice shared decision‐making were studied from the perspective of the patient (Gualano et al, 2019; Skaar et al, 2017), the professional (Driever et al, 2020; Kannan et al, 2020; van Beek‐Peeters et al, 2022; Zeuner et al, 2015) or both (Heggland & Hausken, 2014; Keij et al, 2021). One study (Heggland & Hausken, 2014) also questioned researchers.…”

Heartbeat: healthy lifestyles require community support, not just personal willpower

“…These issues were explored in a semistructured interview study of cardiothoracic surgeons, interventional cardiologists, nurse practitioners and physician assistants involved in decision-making for patients with severe aortic stenosis. 3 Key patterns identified by this process were discrepancies between patients' wishes and treatment options, lack of information about patient preferences, and institutional and patient factors that complicated SDM (figure 2). Interestingly, patient participation in SCM was not considered essential by all providers and patients were not included in this study.…”

“…Yet, there is little data on exactly what we mean by shared decision-making (SDM) and whether this approach is widely implemented in clinical practice. These issues were explored in a semistructured interview study of cardiothoracic surgeons, interventional cardiologists, nurse practitioners and physician assistants involved in decision-making for patients with severe aortic stenosis 3. Key patterns identified by this process were discrepancies between patients’ wishes and treatment options, lack of information about patient preferences, and institutional and patient factors that complicated SDM (figure 2).…”

Heartbeat: shared decision making in care of patients with cardiovascular disease

“…In the accompanying editorial, Lauck and Lewis2 summarise the principles of optimal SDM (figure 2) and point out that “patients who experience shared decision-making report an increased sense of control in managing their illness and improved communication with their healthcare providers, and are more likely to engage in their care and treatment.” Even so, there are many barriers to increased use of SDM in clinical practice 3–6. They conclude that “based on the inclusion of shared decision-making in multiple international guidelines, it is no longer a matter of ‘if’ but rather ‘when’ and ‘how’ clinicians will adopt what is increasingly seen as a best practice in cardiac care.”…”