AHA News Shared Decision-Making and Its Benefits for Patients.

AHA News Shared Decision-Making and Its Benefits for Patients.

Shared Decision-Making: Putting Patients in the Driver’s Seat

Traditionally, many decisions about medical treatment were left up to doctors: They decided, and patients agreed. However, healthcare professionals are now embracing the concept of shared decision-making, where patients become informed partners in their own healthcare choices. A new report from the American Heart Association (AHA), published in the journal Circulation, seeks to make this approach more common in the field of cardiology.

The old model of decision-making, as portrayed in classic medical dramas, depicted a paternalistic approach with doctors making decisions on behalf of patients. Cheryl Himmelfarb, a professor at the Johns Hopkins University School of Nursing in Baltimore and the leader of the expert panel that authored the report, explains that the shift in focus now centers on placing the patient at the center of care. Physicians aim to inform patients about their options and engage them in treatment decisions, asking questions like, “What’s important to you? And what are your priorities and goals as we talk about a treatment plan?” This patient-centered approach is crucial for effective shared decision-making to take place.

The AHA report, issued as a scientific statement, further highlights the importance of shared decision-making, identifies barriers to its implementation, and underscores gaps in related research. Dr. Larry Allen, a cardiologist and professor of medicine at the University of Colorado School of Medicine, emphasizes the widespread recognition in American medicine of the significance of patient engagement in care decisions. In order to successfully engage patients, the report outlines ways in which the healthcare system and clinicians can improve patient involvement.

Shared decision-making originated in cancer care in the 1980s and has gradually spread to other medical fields. Dr. Allen, who co-authored the report, explains that shared decision-making involves a meeting of “two experts,” where the doctor possesses expertise in medical issues and available treatment options while the patient is the expert in their own values and preferences. When executed correctly, this conversation leads to personalized treatment approaches that balance evidence-based care with a patient’s goals.

To illustrate the different approaches to decision-making, Dr. Allen uses the example of a patient with heart failure who may require an implantable cardioverter defibrillator (ICD). Traditionally, a doctor might simply inform the patient that their heart has not responded to medication and refer them to an electrophysiologist to receive an ICD. However, shared decision-making goes beyond this straightforward approach. With shared decision-making, a doctor takes the time to explain that getting an ICD is a reasonable option, but not getting one is also a valid choice. This approach allows the patient to understand the procedure and associated risks fully. Rather than focusing solely on the life-saving benefits of an ICD, the patient is made aware that it does not improve heart function or overall well-being.

It is important to note that shared decision-making has demonstrated numerous benefits. For example, a study published in the journal Circulation: Cardiovascular Quality and Outcomes found that individuals with heart disease who underwent shared decision-making experienced improved physical and mental health, better adherence to medication, lower rates of hospitalization and emergency department use, and reported better communication with their doctors. This positive impact on patient outcomes underscores the value of shared decision-making.

One aspect that shared decision-making seeks to address is implicit or unconscious bias among healthcare professionals. By ensuring that patients and clinicians share the best available evidence, along with individual needs, values, and experiences, shared decision-making promotes equity in healthcare decision-making processes. However, more research is required to determine the optimal approach when dealing with different cultural groups. The scientific statement also highlights barriers to wider adoption, such as limited time during clinic visits and current payment models that do not always align with the goals of shared decision-making.

To enhance shared decision-making, high-quality decision aids that present evidence in an easy-to-understand manner are needed for specific cardiovascular conditions. Additionally, patients must actively participate by asking questions, seeking clarifications, and informing their care team about their goals, priorities, and potential obstacles to following a treatment plan.

Family members and caregivers are also essential in this process; patients should feel comfortable inviting and involving their family members in decision-making, when appropriate. Implementing shared decision-making on a broader scale is still an evolving process. While significant strides have been made in the last decade, there is a need to move from concept to action.

Ultimately, shared decision-making ensures that the remarkable technologies and treatments available in medicine are tailored and applied in a manner that aligns with patients’ values, goals, and preferences. It empowers patients to actively participate in their healthcare and creates a collaborative and informed approach to treatment decisions, resulting in improved overall outcomes.

References 1. American Heart Association. (n.d.). Shared decision-making in cardiovascular care: Putting patients first. Retrieved from AHA website. 2. Merschel, M. (n.d.). Putting patients first: Shared decision-making in cardiology. Retrieved from AHA News website.