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

Megan Coylewright, Dartmouth Hitchcock Medical Center
Roseanne Palmer, Dartmouth Hitchcock Medical Center
Elizabeth S. O'Neill, Dartmouth Hitchcock Medical Center
John F. Robb, Dartmouth Hitchcock Medical Center

Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health;


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