Date of Graduation
Doctor of Nursing Practice (DNP)
Family Nurse Practitioner
Dr. Francine Serafin-Dickson
Dr. Mary Donnelly
Background: The setting for this study is the structural heart program of a large healthcare organization in the Greater Sacramento area in California. Aortic stenosis (AS) is the most common cardiovascular valvular disease in the elderly. The treatment of AS is complex and over the last decade, the transcatheter aortic valve replacement (TAVR) procedure has changed the management of this high-risk group and has become the standard of care.
Problem: The structural heart team performs an average of 170 TAVR procedures annually. The program is relatively new, and although it is performing above the national averages for specific program outcome measures, the evidence-based best practice of Shared Decision-Making (SDM) has not been formally adopted by this team, and therefore not utilized in the pre-TAVR work-up.
Interventions: The goal of implementing the use of an SDM tool is to improve Quality of Life (QOL) outcomes by facilitating meaningful patient participation in decisions related to treatment options available to them using an individualized risk score based on their comorbidities, as well as to consider personal health and lifestyle goals.
Outcome Measures: The outcome measure for this change in practice project aims to achieve a QOL score of 45 points or greater out of 100 at 30 days post-TAVR procedure using the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12). The primary process measure is the utilization rate of the SDM tool for 95% by the structural heart team with patients referred for non-emergent TAVR.
Results: A total of 63 patients underwent the TAVR procedure performed by this structural heart team between March 1 and May 31, 2021. 90.66% of these patients had an increase in their QOL score at or above 45 at 30-days post-TAVR procedure. The SDM tool was utilized with 100% of patients referred to this program for the TAVR procedure within the study period.
Conclusion: The implementation of the SDM tool greatly benefitted the team, patients, and caregivers to ensure everyone was clear on what the patient goals were and how they influenced treatment decisions and patient’s QOL.
Keywords: shared decision-making, quality-of-life, TAVR, aortic stenosis
BUCHNER, LIESEL, "Transcatheter Aortic Valve Replacement: Implementation of Shared Decision-Making" (2021). Doctor of Nursing Practice (DNP) Projects. 266.