Measuring Shared Decision Making
A Review of Constructs, Measures, and Opportunities for Cardiovascular Care
Shared Decision Making: Definition, Framework, and Key Constructs
In the past few decades, patient-centeredness has gained in importance,1,2 and policies to promote patient-centered care have been increasing.3 Several different models of patient-centered care have been described. Although these models vary on their specific definitions and dimensions, they all emphasize the importance of facilitating the engagement of patients in their own healthcare decisions.1,4,5
In some cases, facilitating patient engagement in decisions focuses on ensuring patients receive proven, effective care and do not receive proven, ineffective care. In cardiology, these situations often correspond to American College of Cardiology/American Heart Association class I or III recommendations with strong evidence, and the quality of decisions can be measured by the percentage of eligible patients who receive care that is consistent with the guidelines. Several quality measures endorsed by the National Quality Forum for cardiovascular care fall into these situations, such as the percentage of patients who receive β-blockers at discharge from cardiac surgery or persistence of β-blocker usage after a heart attack except for those patients at low risk.
However, even in situations with class I recommendations, some questions arise in implementing these recommendations into clinical care. For example, the high nonadherence rates for β-blocker therapy (or statin therapy) suggest that patients think differently about the tradeoffs between the potentially modest survival gain and the side effects of the therapy.6,7 In these cases, is it acceptable for patients to decline therapy, and if so, what if any documentation might we need to be confident that the decision was informed and high quality?
As Brindis and Walsh8 highlight in their presidential address, decisions, such as the use of statins for primary prevention, treatment of atrial fibrillation, valve replacement (eg, the use of tissue or mechanical valves), and use of implantable …