Table 1 Identified SDM steps

Quantitative studies

Korteland, 2017

Assess whether the use of patient decision aids result in an improved quality of decision-making in prosthetic heart valve selection compared with standard preoperative care in patients accepted for aortic and mitral valve replacement.

(Decision for TAVI previously made by heart team)

Intervention:

3. Information delivery through patient decision aid online tool: information about and comparison of two options (mechanical / biological heart valve)

4. Patient wishes self-assessed through patient decision aid online tool: exploration of personal feelings and preferences regarding the two options

Control: usual care

Dharmarajan, 2017

Identify patients’ perceptions of their involvement and satisfaction with treatment selection.

(Comparison between SAVR/TAVI (n = 336) group with medical management group (n = 71))

3. Information: 97% of TAVI/SAVR and 88% of medical management group agreed to strongly agreed that HCP helped better understand their AS. 95% of SAVR/TAVI group and 87% of medical management group agreed to strongly agreed to be given enough information about pros and cons.

5.Decision: 96% of SAVR/TAVI and 85% of medical management group agreed to strongly agreed being involved in the decision

Anaya, 2019

Pilot a patient decision aid (DA) which compares mechanical to tissue valve replacement before SAVR

Intervention: DA sent by post mail

3. Information: significant higher conceptual and risk probability knowledge scores in patients that reported using the DA

4. Patient concerns: reoperation (slightly reduced concerns compared to control), severe bleeding and anticoagulants

5. Decision: 50% preferred a tissue valve; 40% being unsure

Control: no DA

4.Patient concerns: reoperation, severe bleeding, taking anticoagulants

5. Decision: 67% preferred a tissue valve; 25% being unsure

Coylewright, 2020

Determine whether the repeated use of a decision aid (DA) by heart teams is associated with greater SDM, along with improved patient-centered outcomes and clinician attitudes about DAs.

Intervention: Repeated use of DA

3. Information delivery by means of decision aids (comparison of TAVI and medical management)

4. Patient wishes: in 41% of cases the elicitation of values and preferences was made by asking questions similar to “What matters most?”

Control: Visits without DA

Schmied, 2015

To determine which information sources and decision criteria are important to patients prior to aortic valve surgery.

3. Information delivery through HCP (no differentiation between pros and cons of various treatment options reported)

4. Patient wishes: improvement of quality of life and prolongation of life

Korteland, 2015

Assess among adult patients accepted for aortic valve replacement: (1) experience with current clinical decision-making regarding prosthetic valve selection, (2) preferences for SDM and risk presentation and (3) prosthetic valve knowledge and numeracy.

3. Information about options: 59% felt they had sufficient knowledge about two options (biological or mechanical valve)

Sugiura, 2022

Evaluate elderly symptomatic severe AS patients’ perspectives on their treatment goals and identify factors that influence their treatment choice.

2. Goal of care: “What do you hope to accomplish by your treatment?“ 77.6% aimed to reduce symptom burden; 68.4% aimed to maintain independence; 62.2% aimed to regain the ability to engage in a specific activity; 58.2% aimed for an improvement of prognosis.

5. Decision: 54.1% reported making the decision based on their values; 52% made a decision based on the wish not to become a burden for the family and 34.7% did not want to become a burden for the society

Bryssinck, 2021

Examine post hoc patient satisfaction and the decision-making process of choosing a prosthesis for aortic valve replacement

3. Information about options: 79.6% felt they were well informed to support their valve choice

4. Patient wishes: 48.7% of the patients believed it is important to be involved in the valve choice

5. Decision: 64.5% of patients stated that the decision was made mainly or only by the HCP and 35.4% stated that the decision was shared between HCP and patient

Qualitative studies

Skaar, 2017

Explore conditions for an autonomous choice experienced by older adults who recently underwent TAVR, with a special focus on relational and cognitive aspects.

3. Information delivery through HCP: only communication of risks in case of no intervention

4. Patient wishes: fear of declining/improvement of quality of life

5. Decision: patients reported making the decision on their own; some reported obligation towards relatives to accept treatment recommendation (TAVI)

Coylewright, 2016

Elicit and report patient-defined goals from elderly patients facing treatment decisions for severe AS.

2. Goals of care: “What do you hope to accomplish by having your valve replaced?“ (i) maintaining independence; (ii) staying alive; (iii) reducing/ eliminating pain or symptoms; and (iv) ability to do a specific activity

Olsson, 2016

Describe the decision-making process about undergoing TAVI treatment among people with severe aortic stenosis.

3. Information: 8 patients reported feeling ambivalent (unsure about the diagnosis, benefits or effects of TAVI as well as method)

Beishuizen, 2021

Assess patient expectations and goals before TAVI, and determine after treatment whether they had been met.

2. Goals of care: “What do you hope to accomplish by undergoing this treatment?“ 48.5% aimed to regain the ability to engage in a specific activity; 27.9% aimed to reduce symptom burden; 11.8% aimed to maintain independence.

Ingle, 2021

Determine decision needs among patients with symptomatic AS

3. Information: Patients seeked information about treatment options

4. Patient wishes: Patients expressed experiencing fear as a consequence of not having enough information or because of illness outcomes.

5. Decision: some patients (number n.a.) expressed the importance of including significant others in deliberating about treatment options. Others expressed the preference to leave the decision to the clinician.

Picou, 2022

Outline the patient experiences related to AS diagnosis, treatment decisions, self-management, and overall personal feelings and psychological impact of the disease.

3. Information: Patients expressed relying on their HCP to gather information for the decision-making process. Patients also searched for additional information elsewhere.

4. Patient wishes: Patients reported making decisions based on their own preferences

Col, 2022

Identify, prioritize, and organize patient-reported goals and features of treatment for severe AS

2. Treatment goals: “What are the specific goals that you think are most important to consider when deciding about treating AS?“: have trust in HCP; receive good information; live a long life; reduce future risks; improve quality of life; reduce decisional regret; be independent.

3. Information: 92.6% of the patients rated information about options when replacing or repairing a valve as very important; 85.3% rated information about intra and post operative risks as very important

4. Patient wishes: 65.8% rated a treatment recommendation from the HCP as very important