SHARED DECISION MAKING IN THE PREVENTION AND MANAGEMENT OF CARDIOVASCULAR DISEASE IN THE OUTPATIENT SETTING: A PILOT PROGRAM

ObjectivesRecent guideline changes for cardiovascular disease (CVD) prevention medication have resulted in calls to implement shared decision-making rather than arbitrary treatment thresholds. Less attention has been paid to existing tools that could facilitate this. Decision aids are well-established tools that enable shared decision-making and have been shown to improve CVD prevention adherence. However, it is unknown how many CVD decision aids are publicly available for patients online, what their quality is like and whether they are suitable for patients with lower health literacy, for whom the burden of CVD is greatest. This study aimed to identify and evaluate all English language, publicly available online CVD prevention decision aids.DesignSystematic review of public websites in August to November 2016 using an environmental scan methodology, with updated evaluation in April 2018. The decision aids were evaluated based on: (1) suitability for low health literacy populations (understandability, actionability and readability); and (2) International Patient Decision Aids Standards (IPDAS).Primary outcome measuresUnderstandability and actionability using the validated Patient Education Materials Assessment Tool for Printed Materials (PEMAT-P scale), readability using Gunning–Fog and Flesch–Kincaid indices and quality using IPDAS V.3 and V.4.ResultsA total of 25 unique decision aids were identified. On the PEMAT-P scale, the decision aids scored well on understandability (mean 87%) but not on actionability (mean 61%). Readability was also higher than recommended levels (mean Gunning–Fog index=10.1; suitable for grade 10 students). Four decision aids met criteria to be considered a decision aid (ie, met IPDAS qualifying criteria) and one sufficiently minimised major bias (ie, met IPDAS certification criteria).ConclusionsPublicly available CVD prevention decision aids are not suitable for low literacy populations and only one met international standards for certification. Given that patients with lower health literacy are at increased risk of CVD, this urgently needs to be addressed.

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Shared Decision Making in Cardiovascular Patient Care to Address Cardiovascular Disease Disparities

Journal of the American Heart Association ◽

10.1161/jaha.120.018183 ◽

2021 ◽

Author(s):

Ruth‐Alma N. Turkson‐Ocran ◽

S. Michelle Ogunwole ◽

Anika L. Hines ◽

Pamela N. Peterson

Keyword(s):

Cardiovascular Disease ◽

Decision Making ◽

Patient Care ◽

Shared Decision Making ◽

Shared Decision ◽

Cardiovascular Patient

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Shared Decision-Making in Older Persons with Cardiovascular Disease

Current Cardiovascular Risk Reports ◽

10.1007/s12170-015-0479-9 ◽

2015 ◽

Vol 9 (12) ◽

Author(s):

Madhav Narayan ◽

Daniel Matlock

Keyword(s):

Cardiovascular Disease ◽

Decision Making ◽

Shared Decision Making ◽

Older Persons ◽

Shared Decision

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PATIENTS’ PERCEIVED VERSUS PREDICTED CARDIOVASCULAR DISEASE RISK: CHALLENGES FOR SHARED DECISION-MAKING IN CHOLESTEROL MANAGEMENT

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(16)31930-1 ◽

2016 ◽

Vol 67 (13) ◽

pp. 1929

Author(s):

Ann Marie Navar Boggan ◽

Tracy Wang ◽

Shuang Li ◽

Michael Pencina ◽

Judith Stafford ◽

...

Keyword(s):

Cardiovascular Disease ◽

Decision Making ◽

Shared Decision Making ◽

Disease Risk ◽

Cardiovascular Disease Risk ◽

Shared Decision ◽

Cholesterol Management

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Measuring shared decision-making in the pediatric outpatient setting: Psychometric performance of the SDM-Q-9 and CollaboRATE among English and Spanish speaking parents in the US Midwest

Patient Education and Counseling ◽

10.1016/j.pec.2018.10.015 ◽

2019 ◽

Vol 102 (4) ◽

pp. 742-748 ◽

Cited By ~ 6

Author(s):

Emily A. Hurley ◽

Andrea Bradley-Ewing ◽

Carey Bickford ◽

Brian R. Lee ◽

Angela L. Myers ◽

...

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Outpatient Setting ◽

Shared Decision ◽

Psychometric Performance ◽

Spanish Speaking ◽

The Us ◽

Us Midwest

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Shared decision-making about cardiovascular disease medication in older people: a qualitative study of patient experiences in general practice

BMJ Open ◽

10.1136/bmjopen-2018-026342 ◽

2019 ◽

Vol 9 (3) ◽

pp. e026342 ◽

Cited By ~ 2

Author(s):

Jesse Jansen ◽

Shannon McKinn ◽

Carissa Bonner ◽

Danielle Marie Muscat ◽

Jenny Doust ◽

...

Keyword(s):

Cardiovascular Disease ◽

Decision Making ◽

General Practice ◽

Older People ◽

Shared Decision Making ◽

Patient Experiences ◽

Shared Decision ◽

Framework Analysis ◽

Cvd Risk ◽

Cvd Prevention

ObjectivesTo explore older people’s perspectives and experiences with shared decision-making (SDM) about medication for cardiovascular disease (CVD) prevention.Design, setting and participantsSemi-structured interviews with 30 general practice patients aged 75 years and older in New South Wales, Australia, who had elevated CVD risk factors (blood pressure, cholesterol)orhad received CVD-related lifestyle advice. Data were analysed by multiple researchers using Framework analysis.ResultsTwenty eight participants out of 30 were on CVD prevention medication, half with established CVD. We outlined patient experiences using the four steps of the SDM process, identifying key barriers and challenges: Step 1. Choice awareness: taking medication for CVD prevention was generally not recognised as a decision requiring patient input; Step 2. Discuss benefits/harms options: CVD prevention poorly understood with emphasis on benefits; Step 3. Explore preferences: goals, values and preferences (eg, length of life vs quality of life, reducing disease burden vs risk reduction) varied widely but generally not discussed with the general practitioner; Step 4. Making the decision: overall preference for directive approach, but some patients wanted more active involvement. Themes were similar across primary and secondary CVD prevention, different levels of self-reported health and people on and off medication.ConclusionsResults demonstrate how older participants vary widely in their health goals and preferences for treatment outcomes, suggesting that CVD prevention decisions are preference sensitive. Combined with the fact that the vast majority of participants were taking medications, and few understood the aims and potential benefits and harms of CVD prevention, it seems that older patients are not always making an informed decision. Our findings highlight potentially modifiable barriers to greater participation of older people in SDM about CVD prevention medication and prevention in general.

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