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Objective superiority of tissue vs mechanical prostheses in surgical aortic valve replacement remains controversial, placing a greater emphasis on patients to consider personal lifestyle and risk preferences, including the burden of lifelong anticoagulation and the possible need for reoperation. A shared decision-making tool may therefore be of value in making this important choice. A patient decision aid (PtDA) was developed using the International Patient Decision Aids Standards and used in a prospective pilot study. An intervention group received the PtDA and a survey. A control group received the same survey without a PtDA. The survey assessed patients' knowledge, treatment preferences, stage of decision-making, and decisional conflict. Both groups received these materials in the mail before their preoperative consultation for surgical aortic valve replacement. Survey results were compared between the 2 groups. Response rates were 13 of 17 (76%) and 10 of 18 (56%) for the control and intervention groups, respectively. Patients in the intervention group who reported reviewing the PtDA (n = 6) demonstrated significantly higher knowledge scores (median 100% vs 25%, P =.02) and were able to produce more accurate risk estimates (median 62.5% vs 0%, P =.01). These patients also had less decisional conflict, with median SURE scores (Sure of myself; Understand information; Risk-benefit ratio; Encouragement) of 4 vs 0 P =.04). Stage of decision-making, concern about risk,s and treatment preferences were similar Use of a PtDA for selection of valve type in surgical aortic valve replacement may improve patient understanding and decisional conflict. Revision of our tool and further studies are warranted to validate these findings in a large cohort of patients. [ABSTRACT FROM AUTHOR]

Objective: To assess how informed patients are about breast reconstruction, and how involved they are in decision making. Summary Background Data: Breast reconstruction is an important treatment option for patients undergoing mastectomy. Wide variations in who gets reconstruction, however, have led to concerns about decision making. Methods: We conducted a prospective cross-sectional study of patients planning mastectomy at a single site, over 20 months. Before surgery, patients completed a survey with validated scales to assess knowledge about breast reconstruction and involvement in decision making. Factors associated with knowledge were examined in a multivariable linear regression model. Results: A total of 145 patients enrolled (77% enrollment rate), and 126 remained eligible. The overall knowledge score was 58.5% (out of 100%). Knowledge about risk of complications was especially low at 14.3%. Knowledge did not differ by treatment (reconstruction or not). On multivariable analysis, non-white race was independently associated with lower knowledge. Most patients (92.1%) reported some discussion with a provider about reconstruction, and most (90.4%) reported being asked their preference. More patients reported discussing the advantages of reconstruction (57.9%) than the disadvantages (27.8%). Conclusions: Women undergoing mastectomy in this sample were highly involved in decision making, but had major deficits in knowledge about the procedure. Knowledge about the risk of complications was particularly low. Providers seemed to have discussed the advantages of reconstruction more than its disadvantages. [ABSTRACT FROM AUTHOR]

The author discusses preference-sensitive decision, the kind of medical decision that is dependent on whether the test or treatment is clinically appropriate and reflects patient's informed goals and preferences. He says that shared decision-making is an example of an approach that will ensure the involvement of patients in deciding on particular treatments whenever possible. Patient decision aids are tools designed to support the approach by matching the right patient to the right treatment.