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



The purpose of this study was to elicit and report patient-defined goals from elderly patients facing treatment decisions for severe AS.



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.



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.



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.
Section of Cardiology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA. megan.coylewright@dartmouth.edu.|The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA. megan.coylewright@dartmouth.edu.
Megan
M
Coylewright
Section of Cardiology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
Roseanne
R
Palmer
Section of Cardiology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
Elizabeth S
ES
O'Neill
Section of Cardiology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
John F
JF
Robb
Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA.|Clinical Epidemiology Research Center, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.
Terri R
TR
Fried
D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D003657:Decision Making; D005260:Female; D006040:Goals; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D010817:Physician-Patient Relations; D036301:Qualitative Research; D012189:Retrospective Studies; D012306:Risk; D012720:Severity of Illness Index; D014481:United States
aortic stenosis; aortic valve replacement; elderly; patient-centred care; shared decision making; transcatheter aortic valve implantation; valve replacement; valvular heart disease