PCI Choice: Cardiovascular clinicians’ perceptions of shared decision making in stable coronary artery disease

Coylewright, Megan; O’Neill, Elizabeth; Dick, Sara; Grande, Stuart W.

doi:10.1016/j.pec.2017.01.010

Cited by 20 publications

(22 citation statements)

References 27 publications

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“…Twenty-five papers met the inclusion criteria including 22 RCTs and 3 qualitative or mixed-methods studies nested in an RCT, together representing 23 unique trials (online supplementary file 1). 13–37 One study was excluded because it had no comparator group without decision aid 38. There were three nested qualitative studies and nine RCTs included in our review that were not included in the Cochrane review, the majority of which were published after April 2015, the date of the literature search for the Cochrane review.…”

Section: Resultsmentioning

confidence: 99%

“…Clinicians perceived the decision aid as useful when it was easy to use and implement into routine clinical care 22 32. One study reported that clinicians felt proud to have additional tools for patients to view and take home 14. Many clinicians reported that patients were more satisfied with care after using the decision aid.…”

Section: Resultsmentioning

confidence: 99%

“…Many clinicians reported that patients were more satisfied with care after using the decision aid. These clinicians recognised that the decision aid may have an added value 14…”

Section: Resultsmentioning

confidence: 99%

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Impact of decision aids used during clinical encounters on clinician outcomes and consultation length: a systematic review

et al. 2018

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BackgroundClinicians’ satisfaction with encounter decision aids is an important component in facilitating implementation of these tools. We aimed to determine the impact of decision aids supporting shared decision making (SDM) during the clinical encounter on clinician outcomes.MethodsWe searched nine databases from inception to June 2017. Randomised clinical trials (RCTs) of decision aids used during clinical encounters with an unaided control group were eligible for inclusion. Due to heterogeneity among included studies, we used a narrative evidence synthesis approach.ResultsTwenty-five papers met inclusion criteria including 22 RCTs and 3 qualitative or mixed-methods studies nested in an RCT, together representing 23 unique trials. These trials evaluated healthcare decisions for cardiovascular prevention and treatment (n=8), treatment of diabetes mellitus (n=3), treatment of osteoporosis (n=2), treatment of depression (n=2), antibiotics to treat acute respiratory infections (n=3), cancer prevention and treatment (n=4) and prenatal diagnosis (n=1). Clinician outcomes were measured in only a minority of studies. Clinicians’ satisfaction with decision making was assessed in only 8 (and only 2 of them showed statistically significantly greater satisfaction with the decision aid); only three trials asked if clinicians would recommend the decision aid to colleagues and only five asked if clinicians would use decision aids in the future. Outpatient consultations were not prolonged when a decision aid was used in 9 out of 13 trials. The overall strength of the evidence was low, with the major risk of bias related to lack of blinding of participants and/or outcome assessors.ConclusionDecision aids can improve clinicians’ satisfaction with medical decision making and provide helpful information without affecting length of consultation time. Most SDM trials, however, omit outcomes related to clinicians’ perspective on the decision making process or the likelihood of using a decision aid in the future.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Impact of decision aids used during clinical encounters on clinician outcomes and consultation length: a systematic review

et al. 2018

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“…In this respect, the introduction of decision aids in cardiovascular clinical practice is not only effective in empowering patients, but may also help to instruct clinicians on optimal implementation of shared decision-making in their clinical practice. 24 Especially for TAA patients who face so many challenges related to their disease, this will make a world of difference and allow for optimal tailoring of both the timing and the preferred treatment strategy from a clinical and a patient perspective.…”

Section: Evidence-based and Shared Treatment Decision-making In Thoramentioning

confidence: 99%

Decision-Making in Thoracic Aortic Aneurysm Surgery—Clinician and Patient View

Gökalp

Takkenberg

2019

Seminars in Thoracic and Cardiovascular Surgery

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Treatment decision-making in thoracic aortic aneurysms of the ascending aorta is complex both with regard to the timing of surgery and with regard to the invasive treatment strategy. From a clinician perspective, it is seen as important to balance the risks of watchful waiting versus preventive surgery and to choose a surgical treatment strategy that will result in the lowest early and late event occurrence. The current clinical practice guidelines and reported outcomes after surgery suggest that there are many gray zones in determining the optimal timing and the type of intervention. From a patient perspective, quality of life and in particular minimization of anxiety and depression due to the fear of aortic rupture or the potential occurrence of complications related to the different treatment strategies are important to consider. Quality of life studies and evidence on the importance of patient participation in decision-making make a strong case for evidence-based shared treatment decision in this complex patient group.

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“…To understand why the decision aid did not make more of a difference, the investigators performed qualitative interviews of the cardiologists in the study. 27 One theme was the timing of the intervention. Patients using the decision aid had already been referred for catheterization, and some felt the process should have occurred earlier.…”

Section: ■ Toward Shared Decision-makingmentioning

confidence: 99%

PCI for stable angina: A missed opportunity for shared decision-making

Rothberg

2018

CCJM

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Percutaneous coronary intervention (PCI) continues to be frequently performed for patients with stable coronary artery disease, despite clear evidence that it provides minimal benefit over optimal medical therapy and entails small but not inconsequential risks. Many patients and doctors do not fully understand the risks and benefits of PCI, even when presented with the evidence, and this makes informed consent challenging. The best approach is shared decision-making, with doctor and patient together choosing the best treatment option after considering the evidence and the patient's preferences.

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PCI Choice: Cardiovascular clinicians’ perceptions of shared decision making in stable coronary artery disease

Cited by 20 publications

References 27 publications

Impact of decision aids used during clinical encounters on clinician outcomes and consultation length: a systematic review

Impact of decision aids used during clinical encounters on clinician outcomes and consultation length: a systematic review

Decision-Making in Thoracic Aortic Aneurysm Surgery—Clinician and Patient View

PCI for stable angina: A missed opportunity for shared decision-making

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