Implementing and evaluating shared decision-making before transcatheter aortic valve implantation with a dedicated pathway and questionnaire

Figure 1. Advantages of the shared decision-making process. This figure summarizes the main benefits of shared decision-making based on the available evidence. These benefits apply for every field of medicine but are particularly relevant for transcatheter aortic valve implantation, where the treatment options also include surgical replacement and medical management, and for the final decision, the patient’s preferences are particularly important. Image created with the help of BioRender.com.

Figure 2. Flow chart depicting the changes in our local practice before (left) and after (right) introducing a formal shared decision-making pathway for transcatheter aortic valve implantation. Before the introduction of the shared decision-making pathway, the patient was communicated the opinion of the multi-disciplinary team by phone and normally, after a discussion with the nurse, decided whether to accept or not. With the shared decision-making pathway, patients are now offered 1 week to visualize the information provided via email/post, talk to their family and/or friends, and build an informed opinion. This permits active participation in the shared decision-making meeting, normally held remotely, where the nurse recapitulates all the details of the aortic stenosis and potential treatment options, to make a shared decision on how to proceed. Image created with the help of BioRender.com.

Figure 3. Global satisfaction scores. There is a statistically significant difference in the global satisfaction between patients who went through the shared decision-making pathway and those who did not (global satisfaction score 4.46 ± 0.14 vs. 3.78 ± 0.30, P < 0.001).

Figure 4. Percentages of positive and negative responses to specific questions. For each couple of bars, left is without shared decision-making pathway and right is with shared decision-making pathway. Questions answered positively/negatively by significantly different percentage of patients are highlighted with a symbol ‘*’. (A) The percentage of patients who were engaged in shared decision-making and responded positively (Likert 4–5) exhibited a higher trend for each question, and four questions reached statistical significance (Q3 P = 0.0161, Q5 P = 0.0123, Q6 P = 0.0111, and Q12 P = 0.0017). The overall percentage of positive responses was significantly higher in the post-shared decision-making group (155/234, 66.2% vs. 289/312, 92.6%, P < 0.001). (B) The percentage of patients who were engaged in shared decision-making and responded negatively (Likert 1–2) exhibited a lower trend for each question, and five questions reached statistical significance (Q3 P = 0.0036, Q6 P = 0.0101, Q7 P = 0.0101, Q8 P = 0.0101, and Q12 P = 0.0101). Only a small proportion of patients in the shared decision-making pathway gave negative answers (4% for Q2, Q5, and Q9, and 7% for Q4). The overall…