The use of shared decision-making aids and peer support may help reduce anxiety and increase confidence among patients with aortic stenosis who are considering TAVR, according to a poster presented Oct. 8 during ACC Quality Summit Virtual.

Kimberlee Einfeld, DNP, RN, et al., designed and implemented a pilot project in a TAVR center between May and August 2019 to analyze the use of shared decision-making aids and peer support. All new patients who were eligible for TAVR were invited to participate. Previous TAVR patients received training to act as peer volunteers. The program's valve coordinator reviewed shared decision-making aids available from ACC's CardioSmart with TAVR candidates during appointments and connected new patients with peer volunteers. Patient anxiety and self-efficacy before and after peer support were assessed using the General Anxiety Disorder (GAD)-7 and Cardiac Self-Efficacy scales. Patients also reported whether they found the decision aids helpful using the Preparation for Decision-Making scale after meeting with their physician. Patients were also interviewed to determine the effectiveness of the pilot program.

In total, 11 patients were assessed for anxiety and self-efficacy, while 12 patients evaluated helpfulness of the decision aids. A peer volunteer was available to connect with new patients on the first attempt in 45% of cases, while 36% and 18% were available on the second and third attempts, respectively. After talking with the peer volunteer, four patients had a decrease in anxiety based on the GAD scale, while five had no change and two had increased anxiety. After receiving peer support, 58% of patients showed a minimal increase in confidence based on the Cardiac Self-Efficacy scale in one or more areas.

All 12 patients who evaluated the decision aids rated them as "somewhat to a great deal helpful" in helping them feel prepared for appointments, promoting discussion with their physician and increasing confidence in decision-making. During interviews, all participants responded positively to the statement, "Tell me about your experience with peer support." Patients reported they were more confident in undergoing TAVR, felt less anxiety about the procedure, and believed their knowledge about the procedure and recovery had increased.

According to the researchers, peer support and shared decision-making aids are cost-effective, resource-friendly interventions that other valve centers could implement. After the intervention, patients were empowered to be active participants in their care and were more confident in making decisions about TAVR, they note. Moving forward, they conclude that additional research is needed to better define the benefits of peer support in the TAVR population and validate the findings.

Clinical Topics: Cardiac Surgery, Cardiovascular Care Team, Invasive Cardiovascular Angiography and Intervention

Keywords: Pilot Projects, Quality Improvement, Self Efficacy, Cost-Benefit Analysis, Decision Making, Transcatheter Aortic Valve Replacement, Physician-Patient Relations, Physicians, Palliative Care, Anxiety, Anxiety Disorders, Registries, Quality Summit

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