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Aims:
Transcatheter aortic valvular replacement (TAVR) is increasingly being performed for elderly patients with aortic stenosis (AS), and current guidelines acknowledge the importance of shared decision-making in their management. This study aimed to evaluate elderly symptomatic severe AS patients' perspectives on their treatment goals and identi...
Contexts in source publication
Context 1
... questionnaire included questions across a wide range of variables (Table S1), comprising three domains: (i) symptom burden during the last month; (ii) patient-defined treatment goals and factors considered important in the choice of treatment; and (iii) patients' preferred places of residence after treatment. ...Similar publications
Purpose
The goal of this study is to examine the chronological development of hospitalized oncology and COVID-19 patients, and compare effects on oncology sub-disciplines for pre-pandemic (2017–19) and pandemic (2020–21) years in the setting of a German university maximum care provider.
Methods
Data were retrospectively retrieved from the hospital...
Citations
... Its prevention therefore represents a priority objective across all levels of healthcare in many geographies. From a patient's perspective, stroke represents the most feared complication of TAVR 8,9 . Contemporary stroke rates related to TAVR remain at 2-4% 3,10,11 , with no significant reduction in recent times 3,4 . ...
Stroke remains a devastating complication of transcatheter aortic valve replacement (TAVR), with the incidence of clinically apparent stroke seemingly fixed at around 3% despite TAVR's significant evolution during the past decade. Embolic showers of debris (calcium, atheroma, valve material, foreign material) are captured in the majority of patients who have TAVR using a filter-based cerebral embolic protection device (CEPD). Additionally, in systematic brain imaging studies, the majority of patients receiving TAVR exhibit new cerebral lesions. Mechanistic studies have shown reductions in the volume of new cerebral lesions using CEPDs, yet the first randomised trial powered for periprocedural stroke within 72 hours of a transfemoral TAVR failed to meet its primary endpoint of showing superiority of the SENTINEL CEPD. The present review summarises the clinicopathological rationale for the development of CEPDs, the evidence behind these devices to date and the emerging recognition of cerebral embolisation in many non-TAVR transcatheter procedures. Given the uniqueness of each of the various CEPDs under development, specific trials tailored to their designs will need to be undertaken to broaden the CEPD field, in addition to evaluating the role of CEPD in non-TAVR transcatheter heart interventions. Importantly, the cost-effectiveness of these devices will require assessment to broaden the adoption of CEPDs globally.
... The search strategy identified 2132 individual publications including two additional studies identified through other means (hand search and reference list search) (Fig. 2). 15 studies were included in the final analysis [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] (for description of the included studies, please see supplementary file 2). Cohen's κ was measured to determine the agreement between the two researchers (NR, DD) on 10% of the overall scope, with a substantial agreement at κ = 0.7975. ...
... Intervention: Repeated use of DA 3. Information delivery by means of decision aids (comparison of TAVI and medical management) 4. Patient wishes: in 41% of cases the elicitation of values and preferences was made by asking questions similar to "What matters most?" Control: Visits without DA Schmied, 2015 To determine which information sources and decision criteria are important to patients prior to aortic valve surgery. 3. Information about options: 59% felt they had sufficient knowledge about two options (biological or mechanical valve) Sugiura, 2022 Evaluate elderly symptomatic severe AS patients' perspectives on their treatment goals and identify factors that influence their treatment choice. ...
... 77.6% aimed to reduce symptom burden; 68.4% aimed to maintain independence; 62.2% aimed to regain the ability to engage in a specific activity; 58.2% aimed for an improvement of prognosis. 5. Decision: 54.1% reported making the decision based on their values; 52% made a decision based on the wish not to become a burden for the family and 34.7% did not want to become a burden for the society Bryssinck, 2021 Examine post hoc patient satisfaction and the decision-making process of choosing a prosthesis for aortic valve replacement 3. Information about options: 79.6% felt they were well informed to support their valve choice 4. Patient wishes: 48.7% of the patients believed it is important to be involved in the valve choice 5. Decision: 64.5% of patients stated that the decision was made mainly or only by the HCP and 35.4% stated that the decision was shared between HCP and patient [29,34,36,38,39,41]. Four studies reported about patient's goals of care regarding immediate care outcomes which can be attributed to the second step of SDM -the key message [30,35,38,40]. ...
Background and Aims
Shared decision making (SDM) and advance care planning (ACP) are important evidence and ethics based concepts that can be translated in communication tools to aid the treatment decision-making process. Although both have been recommended in the care of patients with risks of complications, they have not yet been described as two components of one single process. In this paper we aim to (1) assess how SDM and ACP is being applied, choosing patients with aortic stenosis with high and moderate treatment complication risks such as bleeding or stroke as an example, and (2) propose a model to best combine the two concepts and integrate them in the care process.
Methods
In order to assess how SDM and ACP is applied in usual care, we have performed a systematic literature review. The included studies have been analysed by means of thematic analysis as well as abductive reasoning to determine which SDM and ACP steps are applied as well as to propose a model of combining the two concepts into one process.
Results
The search in Medline, Cinahl, Embase, Scopus, Web of science, Psychinfo and Cochrane revealed 15 studies. Eleven describe various steps of SDM while four studies discuss the documentation of goals of care. Based on the review results and existing evidence we propose a model that combines SDM and ACP in one process for a complete patient informed choice.
Conclusion
To be able to make informed choices about immediate and future care, patients should be engaged in both SDM and ACP decision-making processes. This allows for an iterative process in which each important decision-maker can share their expertise and concerns regarding the care planning and advance care planning. This would help to better structure and prioritize information while creating a trustful and respectful relationship between the participants. PROSPERO 2019. CRD42019124575
