Fig 1.
* We did not require recording of the number of people who received an invitation to participate via either post office mail, email, telephone or hand-delivered information.
Table 1.
Participant characteristics at baseline.
Table 2.
Selected patient and clinician-reported outcomesa.
Fig 2.
HCP: Healthcare professional; SAVR: Surgical aortic valve replacement; SDM: Shared decision-making; TAVR: Transcatheter aortic valve replacement.
Questions were derived from the SDM Process Scale, where the benefits of having TAVR or SAVR were assessed by asking “the reasons you might want to have [TAVR/SAVR]” and the risks or cons were assessed by asking “the reasons you might not want to have [TAVR/SAVR]”.
Fig 3.
For all included outcomes, higher scores are desirable; higher decisional conflict scores reflect less decisional conflict (desirable).
S2 Table in S1 File reports these longitudinal findings. Self-reported knowledge scores similarly improved from 3.52 [1.60] at T0 to 3.78 [1.34] at T1 and 4.82 (1.22) at T2 (p = 0.0018) [linear mixed-effects model]. Actual and perceived knowledge were uncorrelated at T0 (R = -0.017, p = 0.932) but strongly correlated at T2 (R = 0.507; p = 0.016). Patients’ stage of decision-making significantly improved, with more patients moving closer to deciding (mean 2.52 [1.68] at T0 vs 4.27 [1.24] at T2, p = 0.0005) [paired t-test] (Fig 3). Decisional conflict significantly improved from 2.21 [1.61] at T0 to 3.82 [0.66] at T2 (p = 0.0001) [paired t-test], corresponding to fewer people (2/22 [9.09%]) experiencing decisional conflict at T2 compared to T0 (19/29 [65.52%]. Decisional quality improved from 3.41 [0.95] at T0 to 3.73 [0.88] at T2 (p = 0.083) [paired t-test]. At T0, all patients reported that they wanted to participate at least partially in decision-making; no patient wanted to leave treatment decisions to their clinician. Clinicians accurately judged their patient’s role preference in 11/28 [39.3%] encounters, overestimated their patient’s reliance on clinician’s judgement in 11/28 [39.3%] encounters, and underestimated it in 5/28 [17.9%] (S8 Fig in S2 File). Agreement between patient-reported role preferences and clinician judgement of patients’ preferred role was low (Kappa = 0.217 [95% CI -0.078–0.512]).