Supported in principle, challenges prevail: Patients and healthcare professionals' perspectives on the implementation of shared decision-making for the treatment of aortic stenosis
Notice bibliographique
Résumé
Abstract Purpose In Canada, treatment decisions for severe aortic stenosis remain primarily driven by referral patterns and physicians’ recommendations, with uneven integration of patients' perspectives. There is a gap in knowledge translation to implement shared decision-making (SDM) for aortic stenosis treatment to improve patient outcomes and experiences, and help shift the culture of care from clinician-driven to patient-centred. We aimed to explore patients and healthcare professionals’ perspectives and factors influencing shared decision-making implementation in three valvular heart programs across Canada. Methods We conducted a qualitative study using an interpretive description approach. We conducted interviews and focus groups with nurse practitioners, advanced practice nurses, cardiac surgeons, cardiac interventionalists, and patients who have faced valve replacement treatment decisions across three academic hospitals in Canada. We undertook a theory-guided approach to data collection, and constant comparative analysis between transcripts. Results We conducted thirteen interviews with nurses, physicians, and patients who all, in principle, report support and engagement towards SDM. Reflective preliminary analysis of the primary interview data suggested four categories which reveal the factors that influence SDM and demonstrate the extent of SDM use in clinical practice in this context. First, established treatment clinical guidelines, in particular age-specific cutoffs, often serve as the foundation for discussions and recommended options. Second, participants noted that at initial appointments, patients are generally well informed about their options, yet gaps in their understanding of the risks, benefits, and potential outcomes of the treatment options persist and require attention. Third, participants acknowledged that an interdisciplinary approach is crucial to genuine SDM, with team members like nurse practitioners contributing to extended patient interaction and fostering a culture of collaborative decision-making. At a system’s level, recent changes in funding models have enhanced healthcare professionals' interest and motivation to engage in SDM. Conclusions While supported in principle, healthcare professionals contend with several realities that guide their treatment recommendations. The involvement of nurses was identified as critical to engaging patients in SDM, capturing their preferences and situational circumstances, and advocating for them at heart team meetings. These findings offer a multi-leveled lens through which new and innovative implementation strategies can be proposed to overcome identified barriers, which may be useful for heart valve programs wishing to deliberately build SDM-supportive teams and infrastructure that value patient-centred decision-making.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».