Carulli Ermes, Browne Suzy, Woolley Sara, Tindale Alexander, Pottle Alison, Nagle Kate, Lane Rebecca, Chandra Navin, Patel Niket, De Palma Rodney, Barnes Gareth, Kabir Tito, Panoulas Vasileios, Smith David, Smith Robert, Clernon Sharon, Heng Ee Ling, Akhtar Mohammed, Bowers Mark, McGovern Ian, Lüscher Thomas, Dalby Miles
Guy's and St Thomas' NHS Foundation Trust, Harefield Hospital, Department of Cardiology, Hill End Rd, Harefield, Uxbridge UB9 6JH, UK.
Doctoral School in Translational Medicine, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy.
Eur Heart J Open. 2024 Nov 4;4(6):oeae095. doi: 10.1093/ehjopen/oeae095. eCollection 2024 Nov.
Transcatheter aortic valve implantation (TAVI) is an alternative to surgical aortic valve replacement for patients with aortic valve stenosis. The choice between TAVI, surgery, or a conservative approach should be based upon multiple factors including clinical considerations, technical feasibility, and informed patient preference. In this context, engaging patients in a shared decision-making (SDM) process becomes essential, but this practice is generally underused.
To comply with the European and UK national guidelines, in January 2023 we established a structured SDM pathway in which patients are offered virtual/physical decision aids and after 1 week are invited to a meeting to reach a shared decision. From December 2022 to June 2023, a custom-developed questionnaire was prospectively administered to 23 patients prior to, and 38 patients after, the implementation of the SDM pathway. The answers to 12 core questions were recorded on a Likert scale (1-5). Global satisfaction, as measured by mean Likert score, was significantly higher for the post-SDM group than for the pre-SDM group (4.46 ± 0.14 vs. 3.78 ± 0.30, < 0.001). The percentage of positive (Likert 4-5) responses was significantly higher in the post-SDM group (289/312, 92.6% vs. 155/234, 66.2%, < 0.001). The percentage of negative (Likert 1-2) responses was significantly lower in the post-SDM group (5/312, 1.6% vs. 53/234, 22.6%, < 0.001).
The SDM pathway proved effective in delivering SDM in compliance with national and international guidance. A similar approach leveraging digital technology to minimize cost and enhance patient convenience could be implemented for other treatments and across other institutions.
经导管主动脉瓣植入术（TAVI）是主动脉瓣狭窄患者外科主动脉瓣置换术的替代方案。TAVI、手术或保守治疗方法的选择应基于多种因素，包括临床考量、技术可行性以及患者的明智偏好。在此背景下，让患者参与共同决策（SDM）过程变得至关重要，但这种做法普遍未得到充分利用。
为遵循欧洲和英国国家指南，2023年1月我们建立了一个结构化的SDM路径，为患者提供虚拟/实体决策辅助工具，并在1周后邀请他们参加会议以达成共同决策。从2022年12月到2023年6月，在SDM路径实施前对23名患者、实施后对38名患者前瞻性地发放了一份定制问卷。12个核心问题的答案采用李克特量表（1 - 5）记录。通过平均李克特评分衡量的总体满意度，SDM后组显著高于SDM前组（4.46±0.14对3.78±0.30，<0.001）。SDM后组积极（李克特4 - 5）回答的百分比显著更高（289/312，92.6%对155/234，66.2%，<0.001）。SDM后组消极（李克特1 - 2）回答的百分比显著更低（5/312，1.6%对53/234，22.6%，<0.001）。
SDM路径被证明在按照国家和国际指南提供SDM方面是有效的。一种利用数字技术以最小化成本并提高患者便利性的类似方法可用于其他治疗并在其他机构实施。
