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Review
Shared decision making in older patients with symptomatic severe aortic stenosis: a systematic review
  1. Judith J A M van Beek-Peeters1,
  2. Elsemieke H M van Noort2,
  3. Miriam C Faes2,
  4. Annemarie J B M de Vos3,
  5. Martijn W A van Geldorp1,
  6. Mirella M N Minkman4,5,
  7. Nardo J M van der Meer4,6
  1. 1 Department of Cardiothoracic Surgery, Amphia Hospital, Breda, The Netherlands
  2. 2 Department of Geriatrics, Amphia Hospital, Breda, The Netherlands
  3. 3 Nursing Council, Amphia Hospital, Breda, The Netherlands
  4. 4 TIAS, School for Business and Society, Tilburg University, Tilburg, The Netherlands
  5. 5 Vilans, Centre of Expertise for Long-term Care, Utrecht, The Netherlands
  6. 6 Department of Anesthesiology, Amphia Hospital, Breda, The Netherlands
  1. Correspondence to Judith J A M van Beek-Peeters, Cardiothoracic surgery, Amphia Hospital, Breda 4800 RK, The Netherlands; jvanbeek1{at}amphia.nl

Abstract

This review provides an overview of the status of shared decision making (SDM) in older patients regarding treatment of symptomatic severe aortic stenosis (SSAS). The databases Embase, Medline Ovid, Cinahl and Cochrane Dare were searched for relevant studies from January 2002 to May 2018 regarding perspectives of professionals, patients and caregivers; aspects of decision making; type of decision making; application of the six domains of SDM; barriers to and facilitators of SDM. The systematic search yielded 1842 articles, 15 studies were included. Experiences of professionals and informal caregivers with SDM were scarcely found. Patient refusal was a frequently reported result of decision making, but often no insight was given into the decision process. Most studies investigated the ‘decision’ and ‘option’ domains of SDM, yet no study took all six domains into account. Problem analysis, personalised treatment aims, use of decision aids and integrating patient goals in decisions lacked in all studies. Barriers to and facilitators of SDM were ‘individualised formal and informal information support’ and ‘patients’ opportunity to use their own knowledge about their health condition and preferences for SDM’. In conclusion, SDM is not yet common practice in the decision making process of older patients with SSAS. Moreover, the six domains of SDM are not often applied in this process. More knowledge is needed about the implementation of SDM in the context of SSAS treatment and how to involve patients, professionals and informal caregivers.

  • aortic stenosis
  • quality and outcomes of care
  • transcatheter valve interventions
  • valve disease surgery

https://doi.org/10.1136/heartjnl-2019-316055

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    Footnotes

    • Contributors JJAMvB-P, NJMvdM, MMNM, MCF and AJBMdV conceived the idea for the review and participated in the design. JJAMvB-P and EHMvN carried out the literature search, review and analysis of the selected publications. JJAMvB-P, NJMvdM, MMNM and MCF led on the drafting. All authors contributed substantially to writing the paper and all reviewed and approved the final draft.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Disclaimer We certify that this work is novel.

    • Competing interests None declared.

    • Patient consent for publication Not required.

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