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Public Health Service increased risk donor kidneys are discarded 50% more often than nonincreased risk donor kidneys despite equivalent patient and graft survival outcomes. Patient and provider biases as well as challenges in risk interpretation contribute to the underuse of increased risk donor organs. As the ultimate decision to accept or reject an increased risk donor organ results from the patient–provider conversation, there is an opportunity to improve this dialogue. This report introduces the best-case/worst-case communication guide for structuring high-stake conversations on increased risk kidney offers between transplant providers and their patients. Through best case/worst case, providers focus on eliciting patient values and long-term goals. The patient’s unique context can then inform an individualized discussion of “best,” “worst,” and “most likely” outcomes and support the provider’s ultimate recommendation. Transplant providers are encouraged to adopt this communication strategy to enhance shared decision-making and improve patient outcomes.

Despite growing research demonstrating the potential for shared decision making (SDM) to improve health outcomes, patient preferences—including financial trade-offs—are still not routinely incorporated into health care decision making. As the US health care delivery system transitions to rewarding value-based care, the question of “value to whom?” assumes greater importance. To achieve the goals of value-based care, the patient voice must be incorporated into clinical decision making by embedding SDM as a routine part of clinical practice. Identified as a priority by the Centers for Medicare & Medicaid Services (CMS), SDM-related measures and initiatives have already been integrated into CMS’ Center for Medicare and Medicaid Innovation (Innovation Center) demonstration projects (eg, the Oncology Care Model and Transforming Clinical Practice Initiative) and value-based payment programs (eg, the Merit-based Incentive Payment System, Medicare Shared Savings Program) to incentivize more proactive SDM engagement between patients and their providers. Furthermore, CMS has also integrated formal shared decision-making encounters into coverage and reimbursement policies (eg, for implantable cardioverter defibrillators), demonstrating a growing interest in SDM and its potential for eliciting and promoting the integration of patient preferences into the clinical decision-making process. In addition to increasing policy efforts to promote SDM, we need more research investments aimed at understanding how to optimize the science and practice of meaningful SDM. The current landscape and proposed road map for next steps in research, outlined in this review article, will help ensure the transition of pilots and research projects regarding the implementation of SDM into sustainable solutions.

In 1994, to guide patients and surgeons in making informed decisions about organ transplantation and reduce transplant-mediated infectious disease transmission, the Centers for Disease Control and Prevention announced the Public Health Service guidelines for increased risk donor (IRD) organs. This classification identifies donors associated with greater risk for contracting human immunodeficiency virus, hepatitis B virus, and hepatitis C virus as increased risk donors. These donor organs are discarded at higher rates than non-IRD organs, despite equivalent patient and graft survival rates following transplantation. Biases and stigmas, as well as misunderstandings about the term “increased risk,” may contribute to the discard of these high-quality organs. Novel communication strategies regarding the risk of disease transmission from IRD organs are needed to reduce misunderstandings between patients and providers and shift the conversation from probabilities and statistics to patient-centered values and expectations. Using a standardized tool such as Best Case/Worst Case to elicit patients’ preferences and share expected outcomes of accepting versus rejecting an IRD organ has the potential to improve IRD risk communication. The purpose of this article is to elucidate the underutilization of IRD organs, through the example of a potential kidney transplantation, to demystify this complex and high-stakes decision utilizing a novel communication strategy and to propose policy changes to IRD organ management that could result in hundreds of additional lives saved each year.

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BACKGROUND The range of decisions and considerations that women with advanced breast cancer (ABC) face can be overwhelming and difficult to manage. Research shows that most patients prefer a shared decision-making (SDM) approach as it provides them with the opportunity to be actively involved in their treatment decisions. The current engagement of these patients in their clinical decisions is suboptimal. Moreover, implementing SDM into routine clinical care can be challenging as patients may not always feel adequately prepared or may not expect to be involved in the decision-making process. OBJECTIVE Avalere Health developed the <italic>Preparation for Shared Decision-Making</italic> (PFSDM) tool to help patients with ABC feel prepared to communicate with their clinicians and engage in decision making aligned with their preferences. The goal of this study was to validate the tool for its acceptability and usability among this patient population. METHODS We interviewed a diverse group of women with ABC (N=30). Interviews were audiorecorded, transcribed, and double coded by using NVivo. We assessed 8 themes to understand the acceptability and usability of the tool. RESULTS Interviewees expressed that the tool was acceptable for preparing patients for decision making and would be useful for helping patients know what to expect in their care journey. Interviewees also provided useful comments to improve the tool. CONCLUSIONS This validation study confirms the acceptability and usability of the PFSDM tool for women with ABC. Future research should assess the feasibility of the tool’s implementation in the clinical workflow and its impact on patient outcomes.