Study: Shared Decision-Making in Cardiovascular Health is Infrequently Utilized, Despite Benefits

Despite its importance to ethical care and known benefits, shared decision-making (SDM) is infrequently promoted and facilitated in cardiovascular care guidelines, according to research published by JAMA Network Open.

SDM has been shown to facilitate self-determination for patients and promotes patient-centered care among health care professionals, according to the study authors. The use of SDM involves collaboration between providers and patients, wherein both parties work together to make informed decisions about the patient’s care. Studies have shown that SDM improves patient satisfaction, adherence to treatment plans, and health outcomes, as well as promoting patient autonomy while respecting their values and preferences.

In cardiovascular care, SDM can help patients make informed decisions about their treatment options. For example, patients with cardiovascular disease may be able to choose from medications, lifestyle changes, surgery, or a combination. By involving patients in the decision, clinicians can help them understand the risks and benefits of each option and make a decision that works best for them.

SDM can also be incorporated into cardiovascular guidelines by providing decision aids, such as information flyers or online tools, to help patients understand all of their options and make informed decisions. Earlier studies of SDM incorporation have shown that it is largely under-used.

For example, a 2007 review of major Canadian guidelines on diabetes, dyslipidemia, hypertension, and osteoporosis found that only 0.1% of the total words in the guidelines related to SDM and patient preferences. Similarly, a 2019 review found that just 39% of osteoporosis guidelines included any statements about patients’ beliefs, values, and preferences.

To better understand the integration of SDM in current cardiovascular guidelines, investigators conducted a cross-sectional study assessing the newest guidelines or subsequent updates that included pharmacotherapy recommendations. Included literature were published between January 2012 and December 2022 by the American College of Cardiology (ACC), Canadian Cardiovascular Society (CCS), and European Society of Cardiology (ESC).

The study ultimately included 65 cardiovascular guidelines. Of those, 51% broadly supported SDM and emphasized its importance; however, just 6% of pharmacotherapy recommendations incorporated SDM in some form. Among 170 total recommendations that incorporated SDM, the authors said most only noted the importance of patient preferences without addressing how to actually integrate those preferences.

Although these overall findings were less than ideal, the authors did identify 2 guidelines with “commendable” SDM incorporation. In particular, 43% of the pharmacotherapy recommendations in the ACC 2018 cholesterol guideline incorporated SDM, which was approximately 7 times higher than the mean. Additionally, the CCS 2022 cardiometabolic guideline included a summary of findings table that could be used to facilitate SDM by providing estimates of benefits on patient-oriented efficacy outcomes.

Importantly, the authors said broad statements in support of SDM are a starting point, and the ACC’s guidelines are examples in this respect. However, such statements may not provide the necessary support for clinicians who already have major time constraints when implementing guideline-directed care. Therefore, the authors suggested several approaches to improve the incorporation of SDM in future guidelines.

Some potential strategies include changing the wording of recommendations to promote discussion, presenting the benefits and harms of interventions to patients, and incorporating decision aids. Alternatively, guideline panels could adopt a simplified approach by first identifying recommendations amenable to SDM, then wording recommendations about SDM impartially with explicit incorporation of patient values and preferences. Finally, guideline panels should provide information syntheses on the benefits, harms, and other considerations, such as cost, to help inform patient decisions.

Reference

MacDonald L, Turgeon RD. Incorporation of shared decision-making in international cardiovascular guidelines. JAMA Netw Open. 2023;6(9):e2332793. doi:10.1001/jamanetworkopen.2023.32793.