- Shared decision making is appropriate for all medical decisions.
Shared decision making is most easily applied to preference-sensitive decisions, where both clinicians and patients agree that equipoise exists, and decision support helps patients think through, forecast, and deliberate their options. In contrast, behavioral counseling is used when scientific evidence for benefit strongly outweighs harm (e.g. smoking cessation, beta-blocker for HFrEF), and decision support is designed to describe, justify, and recommend.
2. Which trial was performed to test the effectiveness of a shared decision support intervention that included patient and caregiver decision aids for LVAD?
The DECIDE-LVAD trial tested the effectiveness of a shared decision support intervention that included patient and caregiver decision aids for LVAD. Among 6 diverse LVAD centers across the country, 248 patients and 182 of their caregivers were enrolled. The results found that the decision aids increased the quality of patients’ and caregivers’ decisions:
- Patients’ knowledge of 10 key aspects of decision making for LVAD significantly improved with the decision aids (p=0.030).
- Agreement between patients’ stated values and their reported treatment choice significantly improved (p=0.013).
- Caregiver’s values-choice concordance significantly improved (p=0.026).
3. Currently, the Centers for Medicare and Medicaid Services require a shared decision-making interaction in order to provide payment for all procedures except:
a. Lung cancer screening
c. Implantable Cardioverter Defibrillator (ICD)
d. Left atrial appendage occlusion device (LAAC, i.e. Watchman)
Currently, the Centers for Medicare and Medicaid Services does not require a shared decision-making interaction in order to provide payment for LVAD.
4. Who can deliver decision aids in clinical practice?
c. Advanced practice providers
d. Social workers
e. All of the above
Anyone on the team can provide the decision aids. It may be beneficial for the decision aids to be given by multiple team members at different times.
We have found that the best use of the decision aids is at the beginning of patient education, prior to making any decision on treatment. After LVAD implantation, patients and caregivers consistently say they wished they had known about LVAD earlier. However, the decision aids can be used at many points in the decision process.
5. If someone is interested in accessing the free LVAD decision aids, which website would you direct them to?
You can access the free LVAD decision aids, including the downloadable pamphlet and video, at www.patientdecisionaid.org.