Shared decision making: what do clinicians need to know and why should they bother?

Successful implementation of the 2013 American College of Cardiology/American Heart Association cholesterol guidelines hinges on a clear understanding of the clinician-patient risk discussion (CPRD). This is a dialogue between the clinician and patient about potential for atherosclerotic cardiovascular disease risk reduction benefits, adverse effects, drug-drug interactions, and patient preferences. Designed especially for primary prevention patients, this process of shared decision making establishes the appropriateness of a statin for a specific patient. CPRD respects the autonomy of an individual striving to make an informed choice aligned with personal values and preferences. Dedicating sufficient time to high-quality CPRD offers an opportunity to strengthen clinician-patient relationships, patient engagement, and medication adherence. We review the guideline-recommended CPRD, the general concept of shared decision making and decision aids, the American College of Cardiology/American Heart Association Risk Estimator application as an implementation tool, and address potential barriers to implementation.

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“…The clinical role of SDM was recently reviewed (9,11). By definition, the decision is shared, but not necessarily equally.…”

Section: Importance Of Sdmmentioning

confidence: 99%

Clinician-Patient Risk Discussion for Atherosclerotic Cardiovascular Disease Prevention

Martin

Sperling

Blaha

et al. 2015

Journal of the American College of Cardiology

137

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“…For instance, while guidelines panels may assume that the benefits of a preventive intervention outweigh any potential harm, individual patients may not agree with their trade-off. When there is uncertainty in the trade-off between benefits and harms of preventive interventions,5–7 incorporation of patients’ preferences is appropriate and important 8. Accordingly, patients may decide whether to accept or reject such an intervention based on weighing the harms, cost and inconvenience of taking lifelong medication against the potential long-term benefits 9 10…”

Section: Introductionmentioning

confidence: 99%

Patient preferences for cardiovascular preventive medication: a systematic review

Albarqouni

Doust

Glasziou

2017

Heart

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Objective: To systematically review current evidence regarding the minimum acceptable risk reduction of a cardiovascular event which patients feel would justify daily intake of a preventive medication.Methods: We used the Web of Science to track the forward and backwards citations of a set of five key articles until 15 November 2016. Studies were eligible if they quantitatively assessed the minimum acceptable benefit -in absolute values -of a cardiovascular disease preventive medication among a sample of the general population, and required participants to choose if they would consider taking the medication.Results: Of 253 studies screened, we included 22, involving a total of 17,751 participants: 6 studied Prolongation of Life (POL), 12 Absolute Risk Reduction (ARR), and 14 studied Number Needed to Treat (NNT) as measures of risk reduction communicated to the patients. In studies framed using POL, 39-54% (average 48%) of participants would consider taking a medication if it prolonged life <8 months, and 56-73% (average 64%) ≥8 months. In studies framed using ARR, 42-72% (average 54%) of participants would consider taking a medication that reduces their 5-year CV risk by <3%, and 50-89% (average 77%) ≥3%. In studies framed using 5-year NNT, 31-81% (average 60%) of participants would consider taking a medication with a NNT of > 30, and 46-87% (average 71%) £30.Conclusions: Many patients require a substantial risk-reduction before they consider taking a daily medication worthwhile, even when the medication is described as being side-effect free and costless.

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“…The advantages of incorporating shared decision-making (SDM) into adult healthcare include: expanding patients' knowledge about their rehabilitation (Hoffmann et al, 2014;Little et al, 2001), enhancing patients' overall satisfaction (Golin, DiMatteo, Duan, Leae, & Gelberg, 2002;Little et al, 2001), and reducing disagreement with decisions (Golin et al, 2002, Hoffmann et al, 2014. In Malaysia, attitudes of audiologists towards SDM are unknown, as is their level of involvement of adult patients in making decisions regarding their audiological management.…”

Section: Patient-centred Care Approachmentioning

confidence: 99%

“…SDM encourages clinician-patient collaboration in making decisions regarding patients' rehabilitation and involves two-way exchange of information between clinicians and patients Elwyn, Edwards, & Kinnersley, 1999). The joint-participation process should begin after the clinician has provided relevant information to the patient, including rehabilitation options and the best available evidence to assist the patient in making an informed decision (Elwyn, Edwards, Kinnersley, & Grol, 2000;Hoffmann et al, 2014;Lim & Kurniasanti, 2015). The final rehabilitation plan is decided in a collaborative manner based on the available evidence and input from the patient Jordan, Ellis, & Chamber, 2002).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of audiological rehabilitation services for adults with hearing impairment in Malaysia

Ali¹

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The effects of hearing impairment on adult patients and their families have been extensively reported (e.g. communication difficulties, emotional distress and social engagement restrictions, and decreased quality of life). Therefore, audiologists have a responsibility to help patients and their families manage activity limitations and participant restrictions that arise from hearing impairment in the context of the International Classification of Functioning, Disability and Health (ICF). This approach is very much in line with the principles of patient-centred care (PCC) that have been extensively promoted as best practice for the healthcare management of older adults. Despite reports of the benefits of PCC for adult patients in Western countries, including adherence to management plans and reduced recovery time, it is not known whether this approach is incorporated into audiological services for adult patients in Malaysia.The aims of this thesis were to investigate (i) the nature of audiological rehabilitation services for adults with hearing impairment in Malaysia, and (ii) the extent of patient-centredness exhibited by audiologists in Malaysia. To address these aims, a mixed methods approach was used. The quantitative measures were utilised to explore the current practice of audiologists in managing adult patients and to identify the preferences for PCC in audiological management from the perspectives of audiologists and adult patients, while the qualitative measures provided an in-depth view of the implementation of PCC in audiological management. The types of methods utilised were online and paper based surveys, individual semi-structured in-depth interviews, and video observation.Chapter 1 describes Malaysia briefly, with a focus on the field of audiology and the services offered. The ICF framework, which structures this thesis, and the PCC approach, which is the focus of this thesis, is presented in this chapter. Chapter 2 describes the audiological management for adults with hearing impairment and their significant others in the context of the ICF, as recommended by established audiology professional associations. Chapter 2 also includes background on PCC in more detail.Chapter 3 explored the nature of audiological services for adults with hearing impairment in Malaysia, with an emphasis on whether current services addressed patients' overall functioning described in the ICF. In general, the audiologists in Malaysia addressed the hearing impairment and its associated activity limitations and participation restrictions in their ii management of adult patients. However, gaps were identified with there being a strong emphasis on addressing impairment-level impacts. Inadequate infrastructure, resources and facilities in the workplace may have contributed to the gaps in service provision and influenced the current practice of audiological management for patients in Malaysia.Chapter 4 identified the preferences of adult patients for PCC and the level of PCC they received from audiologists. Although the...

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Shared decision making: what do clinicians need to know and why should they bother?

Cited by 269 publications

References 30 publications

Clinician-Patient Risk Discussion for Atherosclerotic Cardiovascular Disease Prevention

Clinician-Patient Risk Discussion for Atherosclerotic Cardiovascular Disease Prevention

Patient preferences for cardiovascular preventive medication: a systematic review

Evaluation of audiological rehabilitation services for adults with hearing impairment in Malaysia

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