Interactive Online Decision Aid Improves Shared Decision-Making For Patients With Severe Aortic Stenosis

A novel interactive, online decision aid used at the point of care among patients with severe aortic stenosis (AS) was strongly endorsed by patients and clinicians, easy to use and improved the quality of shared decision-making with a treatment decision that reflected patient values, according to the results of a feasibility study published in PLOS ONE.

Megan Coylewright, MD, FACC, et al., conducted the prospective pilot study between March and July 2022 at five sites across the U.S., selected for geographic and practice setting diversity. A total of 30 patients with severe AS (30% women, mean age 70.4 years) referred by their heart team and eligible for either transcatheter or surgical aortic valve replacement participated in the study. All had internet access. Of the 14 clinicians who participated, 50% were cardiothoracic surgeons, 42.9% interventionalist cardiologists and 7.1% nurse practitioners; the average years of practice was 12.

The online intervention, called Aortic Valve Improved Treatment Approaches (AVITA), guides patients through a series of steps designed to help patients clarify their goals, values and preferences for treatment and a final patent summary is shared with the heart team before the clinician visit.

To assess patient and clinician views of the decision aid, patients completed an online survey before receiving the AVITA intervention, immediately after the intervention and after the clinician visit. Clinicians completed an online survey after the clinic visit.

Results showed that most patients found AVITA easy to use (89.3%) and that it helped them choose treatment (95.5%). Similarly, most clinicians (80.8%) reported the AVITA summary helped them to understand the patient's values, while two-thirds said it helped for making value-aligned decisions. Patients in the study spent a median of 18 minutes interacting with the intervention. Ultimately, 85.7% of patients endorsed the use of the tool and 84.6% of clinicians said they would use it in future encounters.

"An interactive, individualized patient-centered DA, AVITA, tested in real-world clinical encounters by heart teams, led to informed patient preferences for treatment and aligned clinicians' recommendations with patient preferences, improved the quality of decisions, and made the clinical encounter more efficient overall," write the authors. However, they note gaps shared decision-making skillsets remained, suggesting a need for clinician education.

Coylewright and colleagues are now working with the ACC to add AVITA to CardioSmart's online suite of decision-making aids. CardioSmart contains additional booklets and videos for patients choosing between TAVR and SAVR, as well as hubs for those considering interventions to prevent stroke, or medications or devices to treat HF.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Valvular Heart Disease, Aortic Surgery, Cardiac Surgery and VHD, Interventions and Structural Heart Disease

Keywords: Transcatheter Aortic Valve Replacement, Aortic Valve, Aortic Valve Stenosis, Decision Support Techniques, Patient-Centered Care

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