Shared decision making in older patients with symptomatic severe aortic stenosis: a systematic review

Abstract

This review provides an overview of the status of shared decision making (SDM) in older patients regarding treatment of symptomatic severe aortic stenosis (SSAS). The databases Embase, Medline Ovid, Cinahl and Cochrane Dare were searched for relevant studies from January 2002 to May 2018 regarding perspectives of professionals, patients and caregivers; aspects of decision making; type of decision making; application of the six domains of SDM; barriers to and facilitators of SDM. The systematic search yielded 1842 articles, 15 studies were included. Experiences of professionals and informal caregivers with SDM were scarcely found. Patient refusal was a frequently reported result of decision making, but often no insight was given into the decision process. Most studies investigated the ‘decision’ and ‘option’ domains of SDM, yet no study took all six domains into account. Problem analysis, personalised treatment aims, use of decision aids and integrating patient goals in decisions lacked in all studies. Barriers to and facilitators of SDM were ‘individualised formal and informal information support’ and ‘patients’ opportunity to use their own knowledge about their health condition and preferences for SDM’. In conclusion, SDM is not yet common practice in the decision making process of older patients with SSAS. Moreover, the six domains of SDM are not often applied in this process. More knowledge is needed about the implementation of SDM in the context of SSAS treatment and how to involve patients, professionals and informal caregivers.

Transcatheter aortic valve implantation versus surgical aortic valve replacement in patients with severe aortic stenosis: a systematic review and meta-analysis

“…However, current evidence suggests that clinical practice has not yet effectively incorporated TAVI into shared decision making (SDM) processes in patients with SAS who are at lower levels of risk. 5 The use of decision aids in SDM for patients with SAS has been shown to increase patient knowledge and satisfaction. 6 Yet the provision of too little information within decision aids is frequently described by patients as a critical barrier to the SDM process.…”

“… 6 Yet the provision of too little information within decision aids is frequently described by patients as a critical barrier to the SDM process. 5 Therefore, the aim of our systematic review (SR) was to generate a highly accessible and comprehensive dataset that clearly described the current evidence around the risks that may be associated with TAVI versus SAVR.…”

Quality-of-Life Outcomes After Transcatheter Aortic Valve Implantation in a “Real World” Population: Insights From a Prospective Canadian Database

“…This unique data set can be integrated into the bidirectional process to exchange information between patients and health care providers to reach a high-quality decision based on the best evidence available, and on consideration of patients’ values, priorities, and preferences. 34 , 35 , 36 …”

Transcatheter aortic valve implantation: first choice for aortic stenosis?

“…Another, increasingly relevant viewpoint in this discussion is patient preference [8]. Most patients, if given a choice, prefer less invasive therapy over open-heart surgery.…”