What is the View of Cardiologists and Cardiothoracic Surgeons in the Heart Valve Society Community on Shared Decision-Making?
Jantine J. Lindeboom1, Megan Coylewright2, Jonathan R.G. Etnel1, Anna P. Nieboer3, Joost M. Hartman4, Johanna J.M. Takkenberg1.
1Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands, 2Department of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA, 3Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, Netherlands, 4Department of Cardiothoracic surgery, University Medical Center, Groningen, Netherlands.
Objective: Patient involvement in heart valve disease (HVD) treatment decision-making is consistently recommended in clinical guidelines. We investigated the requirements for effective implementation of shared decision-making (SDM) according to an international community of cardiothoracic professionals specialized in HVD.
Methods: An online questionnaire was developed and sent to all attendees (N=800) of the annual scientific meeting of the Heart Valve Society in April 2018. Face-to-face interviews were also conducted, using a theory-driven interview guide, with cardiologists (N=4) and cardiothoracic surgeons (N=5) who attended the meeting.
Results: 101 professionals completed the survey (response rate 13%). Ninety-one percent agreed to involve patients in decision-making. However, a wide variation among responses was observed. Ninety-four percent felt the heart team recommendation determined the final choice. Nevertheless, 71% was comfortable allowing the patient to choose differently. Professionals from North America had a more positive attitude towards SDM than from other continents (Pearson r=.354; p=.002).
Qualitative review of interviews revealed that 2 out of 9 professionals currently facilitated SDM on regular basis. Interviewees reported facilitating factors to implement SDM adequately in clinical practice would include: more consultation time (7/9), patient information support tools like decision aids (6/9), and the need for training in SDM (3/9). Specifically, clinicians reported a needed focus on communication skills (6/9), better understanding of a SDM process (3/9), and identification and selection of patients who may benefit most from a SDM approach (2/9).
Conclusion: Most professionals agree to involve HVD patients in treatment decisions, yet there is substantial underuse of SDM in clinical practice and a preference for heart teams to dictate final choices. Both aspects underline a more opportune introduction of SDM in the outpatient and clinical setting. Our findings determine important information for requirements to implement SDM, including more patient information support tools and understanding of SDM by dedicated professionals.
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