Pilot Study of a Patient Decision Aid for Valve Choices in Surgical Aortic Valve Replacement.

Abstract

BACKGROUND\nObjective superiority of tissue versus mechanical prostheses in surgical aortic valve replacement (SAVR) 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.\n\n\nMETHODS\nA 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 pre-operative consultation for SAVR. Survey results were compared between the two groups.\n\n\nRESULTS\nResponse rates were 13/17 (76%) and 10/18 (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=0.02), and were able to produce more accurate risk estimates (median 62.5% vs. 0%, p=0.01). These patients also had less decisional conflict (median SURE scores of 4 vs. 0, p=0.04). Stage of decision-making, concern about risks and treatment preferences were similar CONCLUSIONS: Use of a PtDA for selection of valve type in SAVR 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.