Shared Decision Making Resources, Georgetown, ME and University of New England, Biddeford, Maine, United States of America.
Department of Cardiovascular Medicine, University of Louisville School of Medicine, Louisville, Kentucky, United States of America.
PLoS One. 2022 Aug 11;17(8):e0270209. doi: 10.1371/journal.pone.0270209. eCollection 2022.
Guidelines recommend including the patient's values and preferences when choosing treatment for severe aortic stenosis (sAS). However, little is known about what matters most to patients as they develop treatment preferences. Our objective was to identify, prioritize, and organize patient-reported goals and features of treatment for sAS.
This multi-center mixed-methods study conducted structured focus groups using the nominal group technique to identify patients' most important treatment goals and features. Patients separately rated and grouped those items using card sorting techniques. Multidimensional scaling and hierarchical cluster analyses generated a cognitive map and clusters.
51 adults with sAS and 3 caregivers with experience choosing treatment (age 36-92 years) were included. Participants were referred from multiple health centers across the U.S. and online. Eight nominal group meetings generated 32 unique treatment goals and 46 treatment features, which were grouped into 10 clusters of goals and 11 clusters of features. The most important clusters were: 1) trust in the healthcare team, 2) having good information about options, and 3) long-term outlook. Other clusters addressed the need for and urgency of treatment, being independent and active, overall health, quality of life, family and friends, recovery, homecare, and the process of decision-making.
These patient-reported items addressed the impact of the treatment decision on the lives of patients and their families from the time of decision-making through recovery, homecare, and beyond. Many attributes had not been previously reported for sAS. The goals and features that patients' value, and the relative importance that they attach to them, differ from those reported in clinical trials and vary substantially from one individual to another. These findings are being used to design a shared decision-making tool to help patients and their clinicians choose a treatment that aligns with the patients' priorities.
ClinicalTrials.gov, Trial ID: NCT04755426, Trial URL https://clinicaltrials.gov/ct2/show/NCT04755426.
指南建议在为严重主动脉瓣狭窄（sAS）选择治疗方法时纳入患者的价值观和偏好。然而，对于患者在形成治疗偏好时最重要的因素知之甚少。我们的目的是确定、优先排序和组织患者报告的 sAS 治疗目标和特征。
本多中心混合方法研究采用名义小组技术进行了结构化焦点小组，以确定患者最重要的治疗目标和特征。患者分别使用卡片分类技术对这些项目进行评分和分组。多维标度和层次聚类分析生成认知图和聚类。
纳入了 51 名患有 sAS 的成年人和 3 名有治疗选择经验的照顾者（年龄 36-92 岁）。参与者来自美国各地的多个医疗中心和在线。8 次名义小组会议产生了 32 个独特的治疗目标和 46 个治疗特征，这些目标和特征被分为 10 个目标聚类和 11 个特征聚类。最重要的聚类包括：1）对医疗团队的信任，2）有关于治疗选择的信息，3）长期预后。其他聚类涉及治疗的必要性和紧迫性、独立和活跃、整体健康、生活质量、家庭和朋友、康复、家庭护理以及决策过程。
这些患者报告的项目涉及治疗决策对患者及其家庭生活的影响，从决策时到康复、家庭护理以及以后。许多属性以前没有报告过 sAS。患者重视的目标和特征，以及他们对这些目标和特征的重视程度，与临床试验报告的不同，而且个体之间差异很大。这些发现正在被用于设计一个共同决策工具，以帮助患者及其临床医生选择与患者优先事项相一致的治疗方法。
ClinicalTrials.gov，试验 ID：NCT04755426，试验网址 https://clinicaltrials.gov/ct2/show/NCT04755426。
