The traditional paternalistic approach to patient care ― in which treatment decisions are made by doctors without patient input ― is rapidly becoming a thing of the past, replaced by shared decision-making (SDM), in which patients become informed partners in choice of treatment.
A new scientific statement from the American Heart Association (AHA) encourages cardiologists to adopt SDM in everyday practice and reviews strategies to ensure that patients have the knowledge and tools to make informed decisions about their care.
SDM is increasingly embraced in healthcare and is recommended in cardiovascular guidelines, says the writing group, chaired by Cheryl Dennison Himmelfarb, PhD, RN, vice dean for research, Sarah E. Allison Endowed Professor and deputy director, Institute for Clinical Translational Research, Johns Hopkins School of Nursing, Baltimore, Maryland.
“This statement is coming at a critical time when we must increase efforts to improve quality and equity in cardiovascular care. SDM is an important strategy to improve CV [cardiovascular] care by enhancing patient involvement in healthcare decisions, communication between patient and provider, and patient-centered care,” Himmelfarb told theheart.org | Medscape Cardiology.
The statement was published online August 14 in Circulation.
More than 100 randomized controlled trials have demonstrated the benefits of SDM, which include improved communication and patient understanding, acceptance, satisfaction, and involvement in medical decisions, the writing group points out.
For example, a recent study of adults with heart disease showed that greater levels of SDM were associated with better physical and mental health, greater adherence to medication, and lower hospitalization rates.
SDM may also serve as a “driver of health equity so that everyone has just opportunities,” the writing group says.
Several guidelines from the AHA and the American College of Cardiology now recommend SDM in various aspects of CV care, and SDM has become integrated into value-based care. Yet integration of SDM in standard CV practice “remains suboptimal,” the writing group notes.
The statement outlines three key components of SDM: (1) clearly communicate unbiased evidence about risks, benefits, and reasonable alternatives to treatment; (2) provide clinical expertise in a manner that is relevant to the patient; (3) include the patient’s values, goals, and preferences in the decision process.
“The statement outlines strategies to promote SDM in clinical practice, including educating clinicians on communication techniques, engaging multidisciplinary teams, using decision aid tools, and incorporating trained decision coaches to support patients in their CV care decisions,” Himmelfarb told theheart.org | Medscape Cardiology.
One such strategy is the five-step SHARE approach:
Step 1: Seek your patient’s participation.
Step 2: Help your patient explore and compare treatment options.
Step 3: Assess your patient’s value and preferences.
Step 4: Reach a decision with your patient.
Step 5: Evaluate your patient’s decision.
“Ultimately, SDM can support healthcare providers and patients to identify evidence-based treatments, technologies, and plans of care that are best aligned with each patient’s values, goals, and preferences,” Himmelfarb said.
The writing group acknowledges that “multilevel solutions must align to address challenges in policies and reimbursement, system-level leadership and infrastructure, clinician training, access to decision aids, and patient engagement to fully support patients and clinicians to engage in the shared decision-making process and to drive equity and improvement in cardiovascular outcomes.”
This statement was prepared by the writing group committee on behalf of the AHA Council on Cardiovascular and Stroke Nursing; the Council on Clinical Cardiology; the Council on Quality of Care and Outcomes Research; the Council on Hypertension; the Council on the Kidney in Cardiovascular Disease; the Council on Lifelong Congenital Heart Disease and Heart Health in the Young (Young Hearts); the Council on Lifestyle and Cardiometabolic Health; the Council on Peripheral Vascular Disease; the Council on Epidemiology and Prevention; and the Stroke Council.
No commercial funding was provided. Disclosures for members of the writing group are listed with the original article.
Circulation. Published online August 14, 2023. Full text
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Publish date : 2023-09-13 19:14:35
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