A new American Heart Association (AHA) scientific statement, published in the journal Circulation highlights evidence that supports shared decision-making, a term that describes the process of ensuring patients have the knowledge and tools to make decisions about their health in collaboration with their professional health care team.
August 16, 2023 — A new American Heart Association (AHA) scientific statement highlights evidence that supports shared decision-making, a term that describes the process of ensuring patients have the knowledge and tools to make decisions about their health in collaboration with their professional health care team. The statement was published August 14 in the American Heart Association’s flagship, peer-reviewed journal Circulation.
More than 100 trials have demonstrated that shared decision-making improves patient’s understanding, acceptance and satisfaction with their health care, yet adequate levels of shared decision-making occur in as few as 10% of face-to-face consultations across a variety of health care specialties.
The statement details the key components of shared decision-making:
- clearly communicated, unbiased evidence about risks, benefits and reasonable alternatives to treatment;
- clinical expertise provided in a way that is relevant to the patient; and
- inclusion of the patient’s values, goals and preferences in the decision process.
The statement presents models of shared decision-making and ways to measure it in research, in addition to strategies to promote its use. Potential solutions to increase shared decision-making in cardiovascular care include reimbursement for consultations, team-based care, integrating decision aids in electronic records, and training clinicians on communication skills that support shared decision-making more effectively and are sensitive to the cultural, racial, ethnic and language considerations for each patient.
The abstract offers the following:
“Shared decision-making is increasingly embraced in health care and recommended in cardiovascular guidelines. Patient involvement in health care decisions, patient-clinician communication, and models of patient-centered care are critical to improve health outcomes and to promote equity, but formal models and evaluation in cardiovascular care are nascent. Shared decision-making promotes equity by involving clinicians and patients, sharing the best available evidence, and recognizing the needs, values, and experiences of individuals and their families when faced with the task of making decisions. Broad endorsement of shared decision-making as a critical component of high-quality, value-based care has raised our awareness, although uptake in clinical practice remains suboptimal for a range of patient, clinician, and system issues.”
"Strategies effective in promoting shared decision-making include educating clinicians on communication techniques, engaging multidisciplinary medical teams, incorporating trained decision coaches, and using tools (ie, patient decision aids) at appropriate literacy and numeracy levels to support patients in their cardiovascular decisions," noted the authors, writing that the scientific statement “shines a light on the limited but growing body of evidence of the impact of shared decision-making on cardiovascular outcomes and the potential of shared decision-making as a driver of health equity so that everyone has just opportunities.” It further added: “Multilevel solutions must align to address challenges in policies and reimbursement, system-level leadership and infrastructure, clinician training, access to decision aids, and patient engagement to fully support patients and clinicians to engage in the shared decision-making process and to drive equity and improvement in cardiovascular outcomes.”
This statement was prepared by the writing group committee on behalf of ten American Heart Association Councils and, according to the American Heart Association statement, include: Dennison Himmelfarb CR, Beckie TM, Allen LA, Commodore-Mensah Y, Davidson PM, Lin G, Lutz B, Spatz ES; on behalf of the American Heart Association Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Quality of Care and Outcomes Research; Council on Hypertension; Council on the Kidney in Cardiovascular Disease; Council on Lifelong Congenital Heart Disease and Heart Health in the Young; Council on Lifestyle and Cardiometabolic Health; Council on Peripheral Vascular Disease; Council on Epidemiology and Prevention; and Stroke Council.
American Heart Association scientific statements promote greater awareness about cardiovascular diseases and help facilitate informed health care decisions. Scientific statements outline what is currently known about a topic and what areas need additional research. While scientific statements inform the development of guidelines, they do not make treatment recommendations. This new statement was approved by the American Heart Association Science Advisory and Coordinating Committee on May 1, 2023, and the American Heart Association Executive Committee on May 17, 2023.
More information: www.heart.org