How to encourage shared decision-making when treating aortic stenosis
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Diagnosing, treating and managing aortic stenosis (AS) is often a challenging task, especially when the patient has a long life expectancy. Consider, for example, how difficult it can be to choose between transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR); what may look like a straightforward choice at first is often incredibly complex.
A new commentary in JAMA Cardiology examined this very issue, highlighting the significant benefits that can be achieved through shared decision-making (SDM).[1]
“Many of us have met patients with failed tissue valves whose stories of the initial decision-making process illustrate limited engagement and understanding of the decision, leading to distrust,” wrote Megan Coylewright, MD, a structural heart disease specialist with Erlanger Cardiology in Chattanooga, Tennessee. “How is a clinician to efficiently partner with unique patients to discuss rapidly evolving data and effectively incorporate their informed goals and preferences? This process is called SDM.”
SDM, Coylewright noted, is something cardiologists and other cardiology professionals rarely talk about, but it is an important piece of the puzzle. In addition to making patients feel more trusting of their care providers, it can improve their understanding of their own situation and help them take a more active role in their own healthcare.
Coylewright shared three ways that heart teams can work to implement SDM when treating AS:
1. Incorporate decision aids into daily practice
The use of decision aids can help ensure the decision-making process takes advantage of the provider’s knowledge and the patient’s preferences. Coylewright emphasized the importance of a “user-centered design” and noted that such tools already exist for treating severe AS.
Research is still limited on the effectiveness of these strategies on physician behavior, she added, but many large health systems are already requiring decision aids to be used on a regular basis.
2. Build a diverse workforce to treat the world’s diverse patient population
“Recent data confirm that less than 2% of TAVR operators are women, and underrepresented in medicine (URIM) physicians in cardiology remain less than 8% of the entire workforce,” Coylewright wrote. “Diversity across varying fields, including business and science, is correlated with improvements in team and organizational performance. Specifically, research supports that improvement in group dynamics in cardiovascular multidisciplinary teams is linked to better patient outcomes.”
By bringing in more women and URIM physicians, patients can feel more comfortable and “heard” during the SDM process. A patient may feel more at ease asking a question, for example, if they can relate to someone on the heart team.
3. Get the entire cardiovascular care team involved
SDM is not exclusively about cardiologists communicating with their patients. In fact, SDM can include nurses, medical assistants and anyone else the patient may encounter over the course of their visit.
“Debate continues about which clinicians are best poised to lead SDM: referring clinicians are concerned they are not familiar enough with the evolving data, and subspecialists lack knowledge of the patient’s lived experience,” Coylewright wrote. “Heart team physicians, often spending less than 20 minutes with patients and families, need help.”
Read the full commentary here.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.