Harvard Medical School, Boston, Massachusetts.
Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts.
Ann Thorac Surg. 2019 Sep;108(3):730-736. doi: 10.1016/j.athoracsur.2019.03.048. Epub 2019 Apr 16.
Objective superiority of tissue vs mechanical prostheses in surgical aortic valve replacement remains controversial, placing a greater emphasis on patients to consider personal lifestyle and risk preferences, including the burden of lifelong anticoagulation and the possible need for reoperation. A shared decision-making tool may therefore be of value in making this important choice.
A patient decision aid (PtDA) was developed using the International Patient Decision Aids Standards and used in a prospective pilot study. An intervention group received the PtDA and a survey. A control group received the same survey without a PtDA. The survey assessed patients' knowledge, treatment preferences, stage of decision-making, and decisional conflict. Both groups received these materials in the mail before their preoperative consultation for surgical aortic valve replacement. Survey results were compared between the 2 groups.
Response rates were 13 of 17 (76%) and 10 of 18 (56%) for the control and intervention groups, respectively. Patients in the intervention group who reported reviewing the PtDA (n = 6) demonstrated significantly higher knowledge scores (median 100% vs 25%, P = .02) and were able to produce more accurate risk estimates (median 62.5% vs 0%, P = .01). These patients also had less decisional conflict, with median SURE scores (Sure of myself; Understand information; Risk-benefit ratio; Encouragement) of 4 vs 0 P = .04). Stage of decision-making, concern about risk,s and treatment preferences were similar CONCLUSIONS: Use of a PtDA for selection of valve type in surgical aortic valve replacement may improve patient understanding and decisional conflict. Revision of our tool and further studies are warranted to validate these findings in a large cohort of patients.
在外科主动脉瓣置换术中，组织假体与机械假体的优势仍存在争议，这使得患者更加注重个人生活方式和风险偏好，包括终身抗凝的负担和再次手术的可能性。因此，共享决策工具可能对做出这一重要选择具有重要价值。
使用国际患者决策辅助标准开发了一种患者决策辅助工具（PtDA），并在一项前瞻性试点研究中进行了测试。干预组接受 PtDA 和调查。对照组仅接受相同的调查，而没有接受 PtDA。调查评估了患者的知识、治疗偏好、决策阶段和决策冲突。两组患者在接受手术主动脉瓣置换术前的术前咨询前，均通过邮件收到这些材料。比较两组的调查结果。
对照组和干预组的有效应答率分别为 13/17（76%）和 10/18（56%）。报告已审查 PtDA 的干预组患者（n=6）的知识得分显著更高（中位数 100%比 25%，P=0.02），并且能够更准确地估计风险（中位数 62.5%比 0%，P=0.01）。这些患者的决策冲突也较小，SURE 评分中位数（Sure of myself；理解信息；风险-获益比；鼓励）为 4 比 0（P=0.04）。决策阶段、对风险的关注和治疗偏好相似。
在外科主动脉瓣置换术中，使用 PtDA 选择瓣膜类型可能会提高患者的理解和决策冲突。需要进一步修改和验证我们的工具，并在更大的患者队列中验证这些发现。
