Conditions for autonomous choice： a qualitative study of older adults＇ experience of decision-making in TAVR

耐心的自治是在为分享的决策的生物伦理学和一个基础的一个领先的原则。这研究为最近经历了 trans 导管的更老的成年人经验丰富的一种自治选择探索条件必要的大动脉的阀门代替(TAVR ).MethodsQualitative 学习一件有目的的样品的半结构化的会见十更旧(范围 73-89，中部 83.5 年) 在 TAVR 以后的成年人(中部 23 天) 。学习背景是在自从 2010，执行 TAVR 的一所大学医院的一个心脏的部门。当选择似乎难或不在时，分析由系统的文章 condensation.ResultsEven， TAVR 病人故意抓住了处理风险评价，矛盾心理和命运提供他们的机会。他们考虑了衰退比接受与过程有关的风险更坏的治疗。被他们的医生彻底地劝告的经验形成了自治信任的基础。他们为医生建议感到了的信任关于过程和风险减轻了矛盾心理。TAVR 病人表示了与 self-empowerment 一致的感情并且宣称它不得不是他们的决定。甚至这样，选择干预为一项义务到他们的家庭或消极地相信它也是一个自治决定的 reported.ConclusionsOlder TAVR 病人经验可以包含坦率的折衷；象一个有弹性的自我看法一样商讨医生相关性。医生们应该特别知道 how older 成年人微妙的认知衰落和倾向到当获得知情同意时，保存他们能影响他们的医药决策的身份。心脏病专家和另外的供应商可以也使用这些卓见开发更好对如此的固有的复杂性作出回应的新策略。

Background Patient autonomy is a leading principle in bioethics and a basis for shared decision making. This study explores conditions for an autonomous choice experienced by older adults who recently underwent trans-catheter aortic valve replacement （TAVR）. Methods Qualitative study entailing semi-structured interviews of a purposive sample often older （range 73-89, median 83.5 years） adults after TAVR （median 23 days）. The study setting was a cardiac department at a university hospital performing TAVR since 2010. Analysis was by systematic text condensation. Results Even when choice seemed hard or absent, TAVR-patients deliberately took the chance offered them by processing risk assessment, ambivalence and fate. They regarded declining the treatment to be worse than accepting the risk related to the procedure. The experience of being thoroughly advised by their physician formed the basis of an autonomous trust. The trust they felt for the physicians＇ recommendations mitigated ambivalence about the procedure and risks. TAVR patients expressed feelings consistent with self-empowerment and claimed that it had to be their decision. Even so, choosing the intervention as an obligation to their family or passively accepting it was also reported. Conclusions Older TAVR patients＇ experience of an autonomous decision may encompass frank tradeoff; deliberate physician dependency as well as a resilient self-view. Physicians should be especially aware of how older adults＇ subtle cognitive declines and inclinations to preserve their identities which can influence their medical decision making when obtaining in- formed consent. Cardiologists and other providers may also use these insights to develop new strategies that better respond to such inherent complexities.