Physicians' perceptions of shared decision-making for implantable cardioverter-defibrillators: Results of a physician survey.
Journal of cardiovascular electrophysiology
BACKGROUND: Centers for Medicare and Medicaid Services has mandated the use of shared decision-making (SDM) for implantable cardioverter-defibrillator (ICD) implantation. SDM tools help facilitate quality SDM by presenting patients with balanced evidence-based facts related to risk and benefits. Perceptions of ICD implantation may differ based on patients' sex and race.
OBJECTIVE: To determine if and how physicians are incorporating SDM in counseling patients about ICD and if they are aware of sex- and race-based differences in patients' perception of ICDs.
METHODS: This was a pilot study involving an online survey targeting attending physicians who implant ICDs. Physicians were randomly selected by a computer-based program; 350 surveys were sent.
RESULTS: Of the 124 (35%) respondents to the survey, 102 (84%) met the inclusion criteria, and of those, 99 (97%) were adult electrophysiologists. Most physicians (90, 88%) stated they engaged in SDM during the general consent process. Sixty-three (62%) physicians discuss end of life issues while obtaining general consent. Forty-four (43%) physicians said they use an existing SDM tool with the Colorado SDM tool being the most common (39, 89%). The majority of physicians were unaware of sex- and race-based differences in perceptions related to ICD implantation (sex 64, 63% and race 63, 62%).
CONCLUSION: A vast majority of physicians are engaging in SDM; however less than half are using a formal SDM tool, and a minority of physicians were aware of sex- and race-based differences in patients' perception of ICD implantation. Sex- and race-based tools might help address this gap.
Ali-Ahmed F, Matlock D, Zeitler EP, Thomas KL, Haines DE, Al-Khatib SM. Physicians' perceptions of shared decision-making for implantable cardioverter-defibrillators: Results of a physician survey. J Cardiovasc Electrophysiol. 2019 Nov;30(11):2420-2426. doi: 10.1111/jce.14178. Epub 2019 Sep 25. PMID: 31515880.