title: Eliciting Patient Risk Willingness in Clinical Consultations as a Means of Improving Decision-Making of Aortic Valve Replacement.
abstract: BACKGROUND
  Treatment decisions for aortic valve replacement (AVR) should be sensitive to patient preferences. However, we lack knowledge of patient preferences and how to obtain them.
  
  
  RESULTS
  We assessed the mortality risk patients were willing to accept when undergoing AVR by using the Standard Gamble method and aimed to show how this risk willingness was affected by level of disease burden. We report findings from 439 patients, aged >18 years with severe aortic stenosis who were referred for evaluation of AVR to our institution. The vast majority of patients accepted a mortality risk regarded as high or prohibitive according to current guidelines. Of the 439 patients, 51% patients were willing to forego surgery with high mortality risk (8-50%) and 19% were willing accept a prohibitive mortality risk (>50%) as defined in current guidelines. However, the risk willingness varied considerably. Acceptance of prohibitive risk willingness (>50%) was associated with reporting of 3 to 5 different restricting symptoms, with an odds ratio of 4.07 (95% CI 1.56-10.59) opposed by increasing score on EuroQol-Visual Analog Scale, with an odds ratio of 0.99 (95% CI 0.97-1.00). The poor ability to predict risk willingness based on available clinical variables and health status suggests that other factors may be important advocating the need for tools for soliciting patient's preferences individually.
  
  
  CONCLUSIONS
  When undergoing AVR, patients were willing to accept considerably higher perioperative risk than what is considered acceptable in current guidelines and practice. Patient preferences varied considerably, and they should be directly assessed and taken into account in decision-making and guidelines.
  
  
  BACKGROUND
  URL: https://clinicaltrials.gov/. Unique identifier: NCT01794832.
authors.affiliation: Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway amjad.i.hussain@gmail.no.
authors.forename: Amjad I
authors.initials: AI
authors.lastname: Hussain
authors.affiliation: Knowledge Center for the Health Services, Norwegian Institute for Public Health, Oslo, Norway.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Garratt
authors.affiliation: Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway.
authors.forename: Cathrine
authors.initials: C
authors.lastname: Brunborg
authors.affiliation: Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway Faculty of Medicine, University of Trondheim, Norway.
authors.forename: Svend
authors.initials: S
authors.lastname: Aakhus
authors.affiliation: Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
authors.forename: Lars
authors.initials: L
authors.lastname: Gullestad
authors.affiliation: Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
authors.forename: Kjell I
authors.initials: KI
authors.lastname: Pettersen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D001296:Audiovisual Aids; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D016009:Chi-Square Distribution; D002755:Choice Behavior; D003661:Decision Support Techniques; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006304:Health Status; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010358:Patient Participation; D057240:Patient Preference; D011446:Prospective Studies; D012017:Referral and Consultation; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index
keywords: aortic stenosis; cardiovascular diseases; patients; shared decision‐making; surgery; valves