{
  "abstract": "Introduction Aortic stenosis (AS) is the most common serious valve disease in the UK, and its prevalence is expected to rise in an ageing population. Transcatheter aortic valve implantation (TAVI) is increasingly used as an alternative to surgery for patients with symptomatic severe AS, in accordance with international clinical guidelines.However, a proportion of patients receiving TAVI will experience a complication, so shared decision making and informed consent are essential. This is dependent on effective information sharing, which is likely to vary between centres. The goal of this survey was to report current processes for sharing information and gaining consent for elective transfemoral TAVI across the UK.Methods A questionnaire survey was emailed to the lead nurses at the 35 UK TAVI centres. The survey assessed: the timing of obtaining written consent, what risks are routinely discussed, whether patient information tools are provided, and if applicable, details of any specific resources that are shared with patients. We report counts and percentages.Results We received a response from 28/35 (80%) of UK TAVI centres. Consent was most commonly obtained on the day of the procedure (n=16, 57%), the day before (n=6, 21%) or at the pre-assessment clinic (n=6, 21%). Core procedural risks (pacemaker implantation, stroke, vascular complications, bleeding and death) were discussed consistently across all centres. In contrast, other risks such as paravalvular leak, infection and renal failure were discussed only at some centres. All centres quoted risk percentages, but rates varied, for example the routinely quoted risk for a pacemaker ranged from 5-10% (18 centres) to >10% (5 centres) ( figure 1). Almost all centres (n=26, 92%) gave patients supplementary information, most commonly printed leaflets (n=20, 93%) and video (n=8, 29%)(figure 2). For centres that used video resources, most used commercial animation platforms and videos provided by their local trust.Conclusion This national survey provides an overview of consenting practices for elective transfemoral TAVI in the UK. The risks discussed are generally consistent, although the quoted rates varied which may influence patient understanding and expectations.In most cases, the signing of the consent form is a final stage in the process of shared decision making and informed consent. We found that the main mode of patient information delivery regarding the important risks for them to consider is through verbal and written information, which may not be suitable for patients with low health literacy or when there are language barriers. Growing evidence supports the use of multimedia in shared decision making in general, and a recent systematic review found that video animations can improve patient experience and knowledge retention. Evidence of the efficacy of video animations in a TAVI setting is lacking, and this may explain why they are currently used in only a small proportion of UK TAVI centres.Research is needed to identify the optimal methods for communicating risk to patients undergoing elective transfemoral TAVI, and the potential role for video or multimedia resources in shared decision making across a range of clinical settings, demographics, and languages.Abstract 168 Figure 1Risk percentages quoted during the consent process for transfemoral TAVI across UK centres (n=28)Abstract 168 Figure 2Types of supplementary information provided to patients during the consent process for transfemoral TAVI across UK centres (n=28)",
  "authors": [
    {
      "affiliations": [
        "James Cook University Hospital, Middlesbrough, UK"
      ],
      "name": "Joshua Xu"
    },
    {
      "affiliations": [
        "Hull York Medical School, University of York, York, UK"
      ],
      "name": "Presha Sridhar"
    },
    {
      "affiliations": [
        "James Cook University Hospital, Middlesbrough, UK"
      ],
      "name": "Gemma McCalmont"
    },
    {
      "affiliations": [
        "Hull York Medical School, University of York, York, UK",
        "Academic Cardiovascular Unit, South Tees NHS Foundation Trust, Middlesbrough, UK"
      ],
      "name": "Chris Wilkinson"
    },
    {
      "affiliations": [
        "Hull York Medical School, University of York, York, UK",
        "Department of Health Sciences, University of York, York, UK"
      ],
      "name": "Peter Knapp"
    }
  ],
  "title": "168 Consent for elective TAVI procedures in the UK: a snapshot of current practice",
  "uid": "624e66a4-d61c-51a1-a7ba-28b851c704b7"
}