Background Shared decision making (SDM) and advance care planning (ACP) are two patient-centered concepts that support patients, their relatives and healthcare professionals engage in a decision-making process in which patient autonomy is best put into practice. Combining these complex interventions into one may support patients with moderate and high treatment complication risks make better evidence-based informed choices.
The aim of the study was to: (1) To assess how SDM and ACP is being applied in the care of patients with high and moderate treatment complication risks and (2) propose a model to best combine the two tools and integrate them into the care process.
Methods (1) Systematic literature review with focus on the decision-making process of patients with aortic stenosis who need to decide between transcatheter aortic valve implantation (TAVI), surgical aortic valve replacement (SAVR) or palliative care. (2) Abductive reasoning for developing new concepts based on the ones broader used.
Results (1) From 1843 identified individual publications only eight were included. Based on the SDM Model by Makoul and Clayman, seven studies report the integration of some SDM components in the decision-making process and one study reported the use of goals of care (important ACP component). (2) Based on the decision-making process described in the included studies, the existing SDM and ACP literature as well as guidelines, we have developed an integrative SDM and ACP model (please see figure below), which can be integrated in the treatment decision-making process of patients with moderate or high treatment risks.
Conclusion Integration of SDM and ACP for patients with moderate and high treatment risks may ensure a continuous patient-centered support for short and long-term decisions and outcomes.
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