title: Patients' Decision Making About Undergoing Transcatheter Aortic Valve Implantation for Severe Aortic Stenosis.
abstract: Aortic stenosis is the most common valve disease in Western countries, and its prevalence is increasing because of the aging population. Some patients, denied surgery because of high risk, can be offered transcatheter aortic valve implantation (TAVI). These patients are old and have comorbidities, and it is not always easy for them to make the decision about accepting TAVI.
  
  
  
  The aim of this study was to describe the decision-making process about undergoing TAVI treatment among people with severe aortic stenosis who are denied surgery.
  
  
  
  The Swedish participants (n = 24) with a mean age of 80 years who had been offered TAVI all agreed to participate in a presurgical interview. The interviews were recorded, transcribed verbatim, and analyzed using qualitative content analysis.
  
  
  
  Three patterns in the decision-making process about TAVI treatment-ambivalent, obedient, and reconciled-were identified. The ambivalent patient is unsure of the value of treatment and aware of the risks; the obedient patient is unsure of the value of one's own decision and wants to leave the decision to others; the reconciled patient has reached a point where there is no choice anymore and is always sure that the decision to undergo TAVI is right.
  
  
  
  People with aortic stenosis who are offered TAVI need to discuss the risks and benefits in order to participate in decision making about the treatment. They have different patterns in decision making and would benefit from healthcare professionals being observant of them to support them in this process in a manner consistent with their values.
authors.affiliation: Karin Olsson, RN, MSc Care developer, Cardiology, Heart Centre and Department of Public Health and Clinical Medicine, and PhD student at the Department of Public Health and Clinical Medicine and the Department of Nursing, Umeä University, Sweden. Ulf Näslund, MD, PhD Professor, Cardiology, Heart and Centre Department of Public Health and Clinical Medicine, Umeä University, Sweden. Johan Nilsson, MD, PhD Physician, Cardiology, Heart Centre, and researcher at the Department of Public Health and Clinical Medicine, Umeä University, Sweden. Åsa Hörnsten, RN, PhD Professor, Department of Nursing, Umeä University, Sweden.
authors.forename: Karin
authors.initials: K
authors.lastname: Olsson
authors.forename: Ulf
authors.initials: U
authors.lastname: Näslund
authors.forename: Johan
authors.initials: J
authors.lastname: Nilsson
authors.forename: Åsa
authors.initials: Å
authors.lastname: Hörnsten
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis; D003657:Decision Making; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D013548:Sweden; D065467:Transcatheter Aortic Valve Replacement