PONE-D-21-38629What Matters Most to Patients with Severe Aortic Stenosis when Choosing Treatment? Framing the Conversation for Shared Decision MakingPLOS ONE

Dear Dr. Nananda Col,

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Reviewer #1: Yes

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Reviewer #1: Yes

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5. Review Comments to the Author

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Reviewer #1: In their study entitled “What Matters Most to Patients with Severe Aortic Stenosis when Choosing Treatment? Framing the Conversation for Shared Decision Making,” Col and colleagues aim to “identify, prioritize, and organize patient-reported goals and features of treatment” for severe aortic stenosis. They perform a very rigorous study which attempts to minimize investigator bias and identify treatment goals and features, clustering them and assessing associations in an effort to lay the groundwork for the development of shared decision-making tools and relevant patient-focused outcomes in clinical trials.

In their introduction, the authors of this study clearly and succinctly frame the issues and highlight the lack of understanding of patient-reported goals and features of treatment in the literature. As the authors point out, this is an important study which provides information necessary for the development of tools to guide decision-making and future study design, and as such I think it makes an important contribution to the literature. It is also quite timely as there is recent widespread interest in understanding the reasons for the clear undertreatment of AS and the racial and ethnic disparities in treatment. Patient goals and patient-defined treatment features likely play a significant role.

I am an interventional cardiologist with a busy TAVR practice and found the results of this study interesting and illuminating, and in some cases surprising. The results of this study are immediately useful to clinicians who are having these conversations with patients every day, even as we await the authors’ more rigorous extension of this preliminary research.

The methods are well-described and seem appropriate. This research methodology is not familiar to me and seems very particular to this type of research, so the editors could consider adding a reviewer with expertise in this methodology if they have not already.

The results are clearly presented, and the figures complement the text.

The discussion puts the results in appropriate context and the conclusions are appropriate.

Overall, I think the authors are to be congratulated on a well-done study which is immediately relevant to clinical practice and addresses a wide gap in the literature.

Minor comments:

1. Page 2, line 2: “NGT” is not defined prior to its first use.

2. Page 3, line 4: “WCG” is not defined.

3. Could the authors expand a bit more on how the change to virtual groups (rather than in-person) may have affected their results?

4. Can the authors please specify the repository for their data and insert a statement into the methods section about its availability and location?

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Reviewer #1: No

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What Matters Most to Patients with Severe Aortic Stenosis when Choosing Treatment? Framing the Conversation for Shared Decision Making

PONE-D-21-38629R1

Dear Dr. Nananda Col,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

Cécile Oury

Academic Editor

PLOS ONE

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