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Original research
Professionals’ views on shared decision-making in severe aortic stenosis
  1. Judith J A M van Beek-Peeters1,
  2. Jop B L van der Meer1,2,
  3. Miriam C Faes3,
  4. Annemarie J B M de Vos4,5,
  5. Martijn W A van Geldorp1,
  6. Ben J L Van den Branden6,
  7. Ruth E Pel-Littel7,
  8. Nardo J M van der Meer8,9,
  9. Mirella M N Minkman7,8
  1. 1 Cardiothoracic Surgery, Amphia Hospital, Breda, The Netherlands
  2. 2 Erasmus Medical Center, Rotterdam, The Netherlands
  3. 3 Geriatrics, Amphia Hospital, Breda, The Netherlands
  4. 4 Amphia Academy, Amphia Hospital, Breda, The Netherlands
  5. 5 Academy of Nursing Science and Education, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
  6. 6 Interventional Cardiology, Amphia Hospital, Breda, The Netherlands
  7. 7 Vilans, Centre of Expertise for Long-term Care, Utrecht, The Netherlands
  8. 8 TIAS School for Business and Society, Tilburg University, Tilburg, The Netherlands
  9. 9 Catharina Hospital, Eindhoven, The Netherlands
  1. Correspondence to Judith J A M van Beek-Peeters, Cardiothoracic Surgery, Amphia Hospital, Breda 4800 RK, Noord-Brabant, The Netherlands; jvanbeek1{at}


Objective To provide insight into professionals’ perceptions of and experiences with shared decision-making (SDM) in the treatment of symptomatic patients with severe aortic stenosis (AS).

Methods A semistructured interview study was performed in the heart centres of academic and large teaching hospitals in the Netherlands between June and December 2020. Cardiothoracic surgeons, interventional cardiologists, nurse practitioners and physician assistants (n=21) involved in the decision-making process for treatment of severe AS were interviewed. An inductive thematic analysis was used to identify, analyse and report patterns in the data.

Results Four primary themes were generated: (1) the concept of SDM, (2) knowledge, (3) communication and interaction, and (4) implementation of SDM. Not all respondents considered patient participation as an element of SDM. They experienced a discrepancy between patients’ wishes and treatment options. Respondents explained that not knowing patient preferences for health improvement hinders SDM and complicating patient characteristics for patient participation were perceived. A shared responsibility for improving SDM was suggested for patients and all professionals involved in the decision-making process for severe AS.

Conclusions Professionals struggle to make highly complex treatment decisions part of SDM and to embed patients’ expectations of treatment and patients’ preferences. Additionally, organisational constraints complicate the SDM process. To ensure sustainable high-quality care, professionals should increase their awareness of patient participation in SDM, and collaboration in the pathway for decision-making in severe AS is required to support the documentation and availability of information according to the principles of SDM.

  • heart valve prosthesis implantation
  • transcatheter aortic valve replacement
  • aortic valve stenosis
  • quality of health care

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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  • Contributors JJAMvB-P, MMNM, NJMvdM, MCF and AJBMdV conceived the idea for the study and participated in the design. JJAMvB-P and JBLvdM performed the interviews and the analysis of data. JJAMvB-P, JBLvdM, MCF and AJBMdV contributed to interpretation of data. JJAMvB-P drafted the initial draft of the manuscript, which was revised based on the input of all authors. All authors reviewed and approved the final draft. JJAMvB-P is responsible for the overall content as the guarantor.

  • Funding This work was funded by the Amphia Hospital Science Funding (grant 2020-1-010 DiMAS-2).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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