A Study Of Shared Decision Aids In Patients With Heart Valve Replacement

Objectives1.To investigate the present situation and attitudes of patients with cardio valve replacement participating in prosthetic valve selection and analyze its influencing factors,in order to provide references for the construction of CVR patients decision aid.2.To explore the current situation and related factors of CVR patients participation in prosthetic valve selection from doctors' perspectives,in order to formulate the CVR patients'decision aid.3.Based on shared decision making mode to develop a CVR patients decision aid,in order to promote CVR patients participating in prosthetic valve selection,and get out from decesion conflict.MethodsBased on the Ottawa decision support framework,a questionnaire survey was conducted to investigate the current situation,attitude and influencing factors of patients' participation in prosthetic valve selection from the perspective of CVR patients and cardiac surgeons.On the basis of questionnaire survey and literature review,combined with the method of brainstorming,the research team developed the CVR patients decision aid protocols.Through two rounds of Delphi expert consultation,we reviesed the CVR patients decision aid protocols,and finally to construct the plan of CVR patients decision aid.all data collected and analyzed by Excel 2013 and SPSS 22.0 statistical software.Results1.A total of 177 questionnaires of CVR patients were sent out,171 questionnaires were available and the response rate was 96.61%.There are 67 cases(39.18%)don't know which type of prosthetic valve they were replaced,66 cases(38.60%)know all three knowledge points about prosthetic valve.There are 134 patients(78.36%)in low degree of actual participation.There are 123 cases(71.93%)hold a positive attitude to participate in prosthetic valve selection.The results of logistic regression analysis showed that how much knowledge of prosthetic valve the patient knows is an independent factor influencing the actual degree of patients'participation in prosthetic valve selection and their participation attitude.2.A total of 126 questionnaires were distributed to cardic surgeons,124 questionnaires were available and the response rate was 98.41%.100(80.65%)cardiac surgeons conducted preoperative conversation with patients and their relatives.62(50%)of cardiac surgeons knew about shared decision-making.Cardiac surgeons selected prosthetic valve based on 13 factors,include the patient's age(96.0%),long-term anticoagulant treatment compliance(84.7%),risk of bleeding(80.6%),life expectancy(79.0%),female patient's fertility intention(62.1%),previous medical history(66.1%),lifestyle(53.2%),and so on.The mean score of the Shared decision questionnaire for cardiac surgeons was 89.28±13.54.The two items with the lowest scores were "I helped my patient understand all informations"(4.38±0.92)and"My patient and I thoroughly weighed the different treatment options"(4.11±1.10).There was no significant difference in the score of shared decision questionnaire among cardiac surgeons with different age,gender,working years and other characteristics(P>0.05).3.After two rounds of expert consultation,three first-level items,including"information related to prosthetic valve","the basis of decision" and "pre-decision evaluation",13 second-level items and 48 third-level items were constructed.According to the International Patient Decision Aids Standards(IPDAS),the plan of CVR patients decision aid was finally constructed.Conclusions1.CVR patients lack the knowledge about prosthetic valve.Patients are less involving prosthetic valve selection actually but hold positive attitude.Helping patients get knowledge about prosthetic valve is a key factor to promote patients'participation in prosthetic valve selection.Medical staffs can develop and use decision aids to help patients get knowledge of prosthetic valve,so as to promote patients involve in prosthetic valve selection.2.Patients and their relatives are both involved in the selection of prosthetic valve,the subject of CVR patients decision aid should be both of them.Only 50%of cardiac surgeons know the information about SDM,medical staff should be trained to master the core concept of SDM before carrying out SDM.There are 13 factors for cardiac surgeons to choose prosthetic valve,these factors should be fully clarified in the CVR patients decision aid,and the emphasis should be placed on helping patients understand the information related to the decision-making and clarifying the individual selection preference.3.The CVR patients decision aid is feasible,reasonable and scientific,Which can provides a reference for the realization of Shared decision-making between cardiac surgeons and CVR patients.