Clinical Spotlight: The Patient Perspective of Shared Decision Making

Smoking cessation: patient comfort with discussion topicsIn the past year CardioSurve research has found that more than two out of three cardiologists (69%) believe they are very familiar with shared decision making. Additionally, more than four out of five have recently used shared decision making in their practice. But how aware are patients of this increasing level of involvement in their care and, more importantly, how do they perceive this new approach?

In order to better understand the patient view of shared decision making, the ACC has recently conducted a survey with 400 patients diagnosed with heart disease. The findings from this research suggest that the concept of shared decision making is not only becoming more and more mainstream to patients, but is also contributing to enhanced physicianpatient discussions about specific prevention and treatment options.

The vast majority (88%) of patients surveyed believe they experience a number of challenges as a result of their disease, including physical limitations (25%), dietary restrictions (11%) and medication side effects (11%). Aside from the physical impact, financial concerns were also noted by 15% of respondents.

To that end, nearly 4 out of 5 patients (78%) state that they actively engage with their physician during the office visit to clarify treatment issues, prepare questions, discuss personal problems related to the illness, or discuss treatment options. Patients say they are very comfortable discussing potential challenges/barriers to treatment with their doctors (76%), challenges with their health plans (72%), and even financial matters (63%). However, end-of-life discussions are less comfortable (48%).

Effect of Shared Decision MakingEven though these patients are coping with the burden of heart disease, most (84%) feel that they are very involved in decisions made about their heart disease treatment. When asked about shared decision making, more than half of patients (59%) indicate they are familiar with the concept, saying that it enhances the quality of discussions around treatment options. Printed materials are the most readily available decision aids for patients (59%) followed by 3-D visual-aide models (30%). Additionally, computer and web-based tools are available to approximately 1 out of 6 patients. More than two out of three patients (70%) feel that shared decision making is an appropriate approach for every visit; however, 30% of patients believe it would be inappropriate in instances where only one treatment option is available or in potentially life-threatening situations.

Graph: Shared Decision Making AppropiratenessWhen asked about the ACC's new mobile patient decision aid for anticoagulation for non-valvular atrial fibrillation (AFib), more than three out of four rate the tool very favorably and 80% feel it would be very helpful. Additionally, almost 4 out of 5 patients (79%) would be very likely to use this type of tool to help facilitate a physician visit.

Interestingly, nearly an equal majority of physicians (59%) and patients (62%) agree that shared decision making improves the quality of treatment discussions. However, while there are common perceptions between physicians and patients about shared decision making, some gaps exist as well. For instance, physicians (80%) are much more likely to believe that shared decision making lengthens the overall patient visit as compared to patients (45%). Additionally, physicians report using shared decision-making (85%) more frequently than their patients indicate they encounter it (67%).

As the shared decision making approach evolves, the ACC is continuing to develop new resources to facilitate patient involvement in their care. Physicians can direct their patients to for infographics, videos, fact sheets and other tools. The shared decision making aid for AFib can be found at Additionally, the website contains patient education resources among ACC’s growing number of clinical toolkits found there.

Clinical Topics: Arrhythmias and Clinical EP, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: ACC Publications, Atrial Fibrillation, Decision Making, Patient Participation, Office Visits, Decision Support Techniques

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