Cargando…

Patient‐defined goals for the treatment of severe aortic stenosis: a qualitative analysis

BACKGROUND: Patients with severe aortic stenosis (AS) at high risk for aortic valve replacement are a unique population with multiple treatment options, including medical therapy, surgical aortic valve replacement and transcatheter aortic valve replacement (TAVR). Traditionally, in elderly populatio...

Descripción completa

Detalles Bibliográficos
Autores principales: Coylewright, Megan, Palmer, Roseanne, O'Neill, Elizabeth S., Robb, John F., Fried, Terri R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5054836/
https://www.ncbi.nlm.nih.gov/pubmed/26275070
http://dx.doi.org/10.1111/hex.12393
_version_ 1782458669327187968
author Coylewright, Megan
Palmer, Roseanne
O'Neill, Elizabeth S.
Robb, John F.
Fried, Terri R.
author_facet Coylewright, Megan
Palmer, Roseanne
O'Neill, Elizabeth S.
Robb, John F.
Fried, Terri R.
author_sort Coylewright, Megan
collection PubMed
description BACKGROUND: Patients with severe aortic stenosis (AS) at high risk for aortic valve replacement are a unique population with multiple treatment options, including medical therapy, surgical aortic valve replacement and transcatheter aortic valve replacement (TAVR). Traditionally, in elderly populations, goals of treatment may favour quality of life over survival. Professional guidelines recommend that clinicians engage patients in shared decision making, a process that may lead to decisions more aligned with patient‐defined goals of care. Goals of care for high‐risk patients with AS are not well defined in the literature, and patient‐reported barriers to shared decision making highlight the need for explicit encouragement from clinicians for patient involvement. OBJECTIVE: The purpose of this study was to elicit and report patient‐defined goals from elderly patients facing treatment decisions for severe AS. METHODS: This analysis was conducted at Dartmouth‐Hitchcock Medical Center, an academic medical institution. In a retrospective manner, we qualitatively analysed goal statements reported by high‐risk, elderly patients with severe AS evaluated for TAVR between June 2012 and August 2014. RESULTS: Forty‐six patients provided treatment goals during consideration of TAVR and defined preferred outcomes as maintaining independence, staying alive, reducing symptoms or, most commonly, increasing their ability to do a specific activity or hobby. CONCLUSIONS: In the high‐risk patient population considering TAVR, patient‐reported goals may be obtained with a simple question delivered during the clinical encounter. Encouraging patients to define their goals may lead to a greater degree of shared decision making, as advocated in current professional guidelines.
format Online
Article
Text
id pubmed-5054836
institution National Center for Biotechnology Information
language English
publishDate 2015
publisher John Wiley and Sons Inc.
record_format MEDLINE/PubMed
spelling pubmed-50548362016-10-19 Patient‐defined goals for the treatment of severe aortic stenosis: a qualitative analysis Coylewright, Megan Palmer, Roseanne O'Neill, Elizabeth S. Robb, John F. Fried, Terri R. Health Expect Original Research Papers BACKGROUND: Patients with severe aortic stenosis (AS) at high risk for aortic valve replacement are a unique population with multiple treatment options, including medical therapy, surgical aortic valve replacement and transcatheter aortic valve replacement (TAVR). Traditionally, in elderly populations, goals of treatment may favour quality of life over survival. Professional guidelines recommend that clinicians engage patients in shared decision making, a process that may lead to decisions more aligned with patient‐defined goals of care. Goals of care for high‐risk patients with AS are not well defined in the literature, and patient‐reported barriers to shared decision making highlight the need for explicit encouragement from clinicians for patient involvement. OBJECTIVE: The purpose of this study was to elicit and report patient‐defined goals from elderly patients facing treatment decisions for severe AS. METHODS: This analysis was conducted at Dartmouth‐Hitchcock Medical Center, an academic medical institution. In a retrospective manner, we qualitatively analysed goal statements reported by high‐risk, elderly patients with severe AS evaluated for TAVR between June 2012 and August 2014. RESULTS: Forty‐six patients provided treatment goals during consideration of TAVR and defined preferred outcomes as maintaining independence, staying alive, reducing symptoms or, most commonly, increasing their ability to do a specific activity or hobby. CONCLUSIONS: In the high‐risk patient population considering TAVR, patient‐reported goals may be obtained with a simple question delivered during the clinical encounter. Encouraging patients to define their goals may lead to a greater degree of shared decision making, as advocated in current professional guidelines. John Wiley and Sons Inc. 2015-08-14 2016-10 /pmc/articles/PMC5054836/ /pubmed/26275070 http://dx.doi.org/10.1111/hex.12393 Text en © 2015 The Authors. Health Expectations Published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution (http://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Research Papers
Coylewright, Megan
Palmer, Roseanne
O'Neill, Elizabeth S.
Robb, John F.
Fried, Terri R.
Patient‐defined goals for the treatment of severe aortic stenosis: a qualitative analysis
title Patient‐defined goals for the treatment of severe aortic stenosis: a qualitative analysis
title_full Patient‐defined goals for the treatment of severe aortic stenosis: a qualitative analysis
title_fullStr Patient‐defined goals for the treatment of severe aortic stenosis: a qualitative analysis
title_full_unstemmed Patient‐defined goals for the treatment of severe aortic stenosis: a qualitative analysis
title_short Patient‐defined goals for the treatment of severe aortic stenosis: a qualitative analysis
title_sort patient‐defined goals for the treatment of severe aortic stenosis: a qualitative analysis
topic Original Research Papers
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5054836/
https://www.ncbi.nlm.nih.gov/pubmed/26275070
http://dx.doi.org/10.1111/hex.12393
work_keys_str_mv AT coylewrightmegan patientdefinedgoalsforthetreatmentofsevereaorticstenosisaqualitativeanalysis
AT palmerroseanne patientdefinedgoalsforthetreatmentofsevereaorticstenosisaqualitativeanalysis
AT oneillelizabeths patientdefinedgoalsforthetreatmentofsevereaorticstenosisaqualitativeanalysis
AT robbjohnf patientdefinedgoalsforthetreatmentofsevereaorticstenosisaqualitativeanalysis
AT friedterrir patientdefinedgoalsforthetreatmentofsevereaorticstenosisaqualitativeanalysis