Abstract
Shared decision making (SDM) has been advocated to improve patient care, patient decision acceptance, patient-provider communication, patient motivation, adherence, and patient reported outcomes. Documentation of SDM is endorsed in several society guidelines and is a condition of reimbursement for selected cardiovascular and cardiac arrhythmia procedures. However, many clinicians argue that SDM already occurs with clinical encounter discussions or the process of obtaining informed consent and note the additional imposed workload of using and documenting decision aids without validated tools or evidence that they improve clinical outcomes. In reality, SDM is a process and can be done without decision tools, although the process may be variable. Also, SDM advocates counter that the low-risk process of SDM need not be held to the high bar of demonstrating clinical benefit and that increasing the quality of decision making should be sufficient. Our review leverages a multidisciplinary group of experts in cardiology, cardiac electrophysiology, epidemiology, and SDM, as well as a patient advocate. Our goal is to examine and assess SDM methodology, tools, and available evidence on outcomes in patients with heart rhythm disorders to help determine the value of SDM, assess its possible impact on electrophysiological procedures and cardiac arrhythmia management, better inform regulatory requirements, and identify gaps in knowledge and future needs.
| Original language | English (US) |
|---|---|
| Pages (from-to) | E007958 |
| Journal | Circulation: Arrhythmia and Electrophysiology |
| Volume | 14 |
| Issue number | 12 |
| DOIs | |
| State | Published - Dec 1 2021 |
Funding
Dr Chung receives research funding from National Institutes of Health (NIH) grants R01 HL111314 and R01 HL158071; American Heart Association (AHA) Atrial Fibrillation Strategically Focused Research Network grant 18SFRN34110067, 18SFRN34170013; and the NIH National Center for Research Resources for Case Western Reserve University and Cleveland Clinic Clinical and Translational Science Award UL1-RR024989. Dr Allen receives research funding from the AHA Strategically-Focused Research Network in Heart Failure grant, NIH 1R01HL136403, and PCORI SDM-2017C2-8640. Dr Baykaner receives research funding from NIH grant K23HL145017. Dr Benjamin receives research funding from NIH grants R01HL092577; R01 HL141434; R01AG066010; and R01AG066914; and the AHA Atrial Fibrillation Strategically Focused Research Network grant AHA 18SFRN34110082. Dr Cavanaugh receives research funding from AHA Atrial Fibrillation Strategically Focused Research Network grants 18SFRN34110369 and 18SFRN34110489. Dr Chen receives research funding from NIH grants R01HL141288, R01 HL126637, and K24HL155813. Dr Delaney receives research funding from the NIH Ruth L. Kirschstein National Research Service Award T32HL007576 from NHLBI. Dr Eckhardt receives research funding from NIH NHLBI grant R01 HL139738-01; Dr Eckhardt is funded in part by the Gary and Marie Weiner Professor in Cardiovascular Medicine Research. Dr Fagerlin receives research funding from the AHA Atrial Fibrillation Strategically Focused Research Network grant 18SFRN34110489 and AHA Children\u2019s Strategically Focused Research Network grant 17SFRN33660465. Dr Grady receives research funding from NIH grants NIA (R01AG047416) and NHLBI R01HL130502. Dr Kramer receives research funding from NIH grant R01HL136403. Dr Kunneman receives research funding from NIH NHLBI grant R01 HL131535-01. Dr Lampert receives research support from Medtronic and Abbott/St. Jude. Dr Langford receives research funding from NIH/NHLBI grant K01HL135467. Dr Lewis receives research funding from Cardiac Arrhythmia Network of Canada (CANet) as part of the Networks of Centres of Excellence and Canadian Cardiovascular Society ECA3-002, and Heart and Stroke Foundation Bridge Funding. Dr Martinez receives research funding from NIH/NHLBI grant K01 HL136656. Dr McCarthy receives research funding from the AHA Atrial Fibrillation Strategically Focused Research Network grant 18SFRN34230146. Dr Montori receives research funding from the AHA Atrial Fibrillation Strategically Focused Research Network grant 18SFRN34230146. Dr Noseworthy receives research funding from NIH grants NIA R01AG 062436-1, NHLBI R01 HL 131535-4, R01 HL143070-2, R21AG 62580-01; Agency for Healthcare Research and Quality (AHRQ) R01HS 25402-03, Food and Drug Administration (FDA) FD 06292, and the AHA 18SFRN34230146. Dr Ozanne receives research funding from the AHA Atrial Fibrillation Strategically Focused Research Network grant 18SFRN34230142. Dr Passman receives research funding from the AHA Atrial Fibrillation Strategically Focused Research Network grant. Dr Roden receives research funding from the AHA Atrial Fibrillation Strategically Focused Research Network grant 18SFRN34110369. Dr Stacey receives support from the Washington State Health Care Authority; travel funds for the Shared Decision Making Advisory Board Meeting in Veile, Denmark, and from the Joint Commission of Taiwan for meetings in Taipei. Dr Steinberg receives research funding from NIH grant K23HL143156. Dr Wang receives research funding from the AHA Atrial Fibrillation Strategically Focused Research Network grant 18SFRN34120036.
Keywords
- arrhythmias, cardiac
- decision making, shared
- documentation
- electrophysiology
- informed consent
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Physiology (medical)
