Improving patient-centred decisions in severe aortic stenosis care

SDM is a collaborative process that helps professionals recognise the valuable knowledge patients and their caregivers contribute to high-quality decisions. It integrates the expertise of professionals with the unique perspectives of patients. While patients are not expected to be treatment experts, they are encouraged to share their values and preferences, to ensure the best AS treatment for their personal situation.

Research on a goal-oriented SDM model has shown that patients’ personalised treatment goals are often missing in decision-making for severe AS [7]. While real-world conversations may differ, starting with the patient’s treatment goals is essential. Professionals should simply ask their patients: ‘What do you hope to do (again) after heart valve treatment?’ (Fig. 1). This question helps to gather patient input, shifts the focus from the disease to personal goals and values and aids in setting realistic treatment expectations.

Before consultations, the responsibility of asking this goal question can be assigned to the professional, such as the cardiologist, nurse practitioner or nurse. It must be ensured that all professionals acknowledge the patient’s response, and clear communication protocols are needed for consistency and clarity. Since SDM is ongoing and treatment goals for severe AS may change, repeating the goal question throughout the patient journey is also required.

Effective SDM requires patients and their informal caregivers to take an active role in decision-making. Older patients, even those with low education levels or cognitive impairments, are often willing to participate in SDM when supported appropriately [8]. Informal caregivers can play a vital role in clarifying the patient’s personal contexts and facilitating communication with professionals.

Patient decision aids (PDAs) support SDM by guiding conversations between professionals and patients, but they must meet quality standards to be effectively implemented [8]. Integrating PDAs into workflows can be challenging, especially in cardiovascular practice. A Question Prompt List (QPL) is a structured tool to assess a patient’s personal situation and preferences and is designed to help patients prepare for medical consultations [8]. It includes a list of questions that patients can answer prior to these consultations. For severe AS, we are introducing a QPL with 4 key questions—covering daily living, goals/constraints, concerns and priorities—which can help patients define their treatment goals and engage more effectively in SDM (Fig. 1).

Context information about a patient’s living situation, social relations, daily activities, frailty and cognitive status is often missing in care pathways [9]. This information is essential for tailoring treatment to individual needs. For example, in many heart centres, the treatment plan is developed without the physical presence of the referring cardiologist and without seeing the patient in the outpatient clinic beforehand, leading to decisions that may not align with the patient’s unique situation [9, 10].

To address this gap, professionals should redesign information flows to include context data as a standard part of the care process. This information can be obtained from other professionals involved in the patient journey, such as general practitioners and geriatricians, or may be collected by the referring cardiologist in collaboration with nurses and nurse practitioners. Context information to be shared should include 5 elements: the patient’s living situation, social relations, daily activities, G8 scale (for frailty) [11] and the Six-Item Cognitive Impairment Test (6-CIT) ([12]; Fig. 1). Standardised forms or digital tools can facilitate the collection and sharing of this information across the care pathway, ensuring that all professionals involved in the patient journey have access to relevant context data.