Shared Decision-Making in Severe Aortic Stenosis: Experiences and Needs of Older Patients.

Abstract

Background: The experiences and preferences of older patients regarding shared decision-making (SDM) for managing severe aortic stenosis (AS) and its impact on health outcomes are not well known.

Objective: The purpose of this study was to provide insight into the experiences, preferences, and needs for SDM of older patients with severe AS and the associations between perceived SDM levels and patients' quality of life, depression, and anxiety.

Methods: A descriptive, exploratory multiple-methods study was conducted using a survey, focus groups, and individual interviews with patients 70 years and older with severe AS. Data were collected at baseline and at 3-month follow-up. Quantitative data were analyzed using multivariate linear regression and quantitative data using qualitative thematic analysis.

Results: Quantitative analysis (n = 120) showed that 29.6% of patients reported maximum scores for the perceived SDM level. In addition, the perceived SDM level was significantly associated with the quality of life category environment ( B = 2.75; 95% confidence interval, 0.90-4.61; P = .004). Professionals' identification of discussion partners was reported by 41.3% of patients, and 52% of patients reported professionals' exploration of patients' daily lives. For future decision-making, 55.6% of patients preferred a collaborative role. Qualitative analysis of 2 focus groups (n = 10) and interviews (n = 7) revealed patients' preference for informal caregivers' support for decision-making. Patients expressed caution in sharing views on their daily lives and expectations and suggested better preparation and goal exploration for decision-making.

Conclusions: To align with SDM and personalize the decision-making process, healthcare professionals must foster patient input and engage informal caregivers. Patients must reflect on their daily activities to define their treatment goals.