Establishment and clinical impacts of decision-support system for older patients with aortic valve stenosis: A retrospective observational study

IF 4.1 2区医学 Q1 PSYCHIATRY

General hospital psychiatry Pub Date : 2025-01-01 DOI:10.1016/j.genhosppsych.2024.12.024

Sayoko Kawano , Yoko Eguchi , Azusa Oosumi , Hiroyoshi Takeuchi , Michiyo Takubo , Noriko Kimura , Naomi Nakano , Toshinobu Ryuzaki , Kentaro Hayashida , Masaki Ieda , Hiroyuki Uchida , Masaru Mimura , Daisuke Fujisawa

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引用次数: 0

Abstract

Objectives

Treatment decisions for severe aortic stenosis (AS) are complex, since there are two active and comparable options: transcatheter aortic valve implantation and surgical aortic valve replacement. The disease predominantly affects older individuals, who are frequently comorbid with from cognitive impairment. This study aimed to establish a screening-triggered system to assess the decision-making capacity of patients with AS, support their decision-making, and facilitate referrals to specialists when necessary.

Methods

This is a retrospective pre-post observational study. Relevant healthcare professionals were trained to assess and support patients' decision-making capacities.

Results

Subtotals of 203 and 244 patients were enrolled before and after the implementation of the system, respectively. The requests for decision-making support significantly increased (from 1.5 % to 14.8 % of the patients). 11.5 % of the patients were identified as with declined decision-making capacity. The proportion of patients who received active treatments for AS significantly decreased from 95.0 % to 83.0 %. The nurses' documentation of patients' decision-making capacities significantly increased.

Conclusion

This screening-triggered system identified a substantial proportion of patients with declined decision-making capacity. A significant decrease in patients receiving active treatments for AS and increased documentation of patients' decision-making capacities in nursing records were observed. A future randomized controlled is warranted.

查看原文本刊更多论文

老年主动脉瓣狭窄患者决策支持系统的建立及临床影响：一项回顾性观察研究。

目的：严重主动脉瓣狭窄（AS）的治疗决策是复杂的，因为有两种积极的和可比较的选择：经导管主动脉瓣植入术和手术主动脉瓣置换术。这种疾病主要影响老年人，他们经常与认知障碍合并症。本研究旨在建立一个筛查触发系统来评估AS患者的决策能力，支持他们的决策，并在必要时方便转诊给专家。方法：回顾性观察前后研究。对相关保健专业人员进行了培训，以评估和支持患者的决策能力。结果：在系统实施前后，分别有203例和244例患者入组。要求决策支持的患者显著增加（从1.5%增加到14.8%）。11.5%的患者被确定为决策能力下降。接受积极治疗的AS患者比例从95.0%显著下降到83.0%。护士对患者决策能力的记录显著增加。结论：该筛查触发系统识别了相当比例的决策能力下降的患者。观察到，接受积极治疗的AS患者显著减少，护理记录中患者决策能力的记录增加。未来的随机对照是有必要的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

General hospital psychiatry 医学-精神病学

CiteScore

9.60

自引率

2.90%

发文量

125

审稿时长

20 days

期刊介绍： General Hospital Psychiatry explores the many linkages among psychiatry, medicine, and primary care. In emphasizing a biopsychosocial approach to illness and health, the journal provides a forum for professionals with clinical, academic, and research interests in psychiatry''s role in the mainstream of medicine.