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Using Patient Decision Aids for Cardiology Care in Diverse Populations

  • Diversity and Health Equity in Cardiology (AE Johnson, Section Editor)
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Abstract

Purpose of Review

Patient decision aids (PDAs) are tools that help guide treatment decisions and support shared decision-making when there is equipoise between treatment options. This review focuses on decision aids that are available to support cardiac treatment options for underrepresented groups.

Recent Findings

PDAs have been developed to support multiple treatment decisions in cardiology related to coronary artery disease, valvular heart disease, cardiac arrhythmias, heart failure, and cholesterol management.

Summary

By considering the unique needs and preferences of diverse populations, PDAs can enhance patient engagement and promote equitable healthcare delivery in cardiology. In this review, we examine the benefits, challenges, and current trends in implementing PDAs, with a focus on improving decision-making processes and outcomes for patients from underrepresented racial and ethnic groups. In addition, the article highlights key considerations when implementing PDAs and potential future directions in the field.

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References

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  1. Stacey D, Légaré F, Lewis K, Barry MJ, Bennett CL, Eden KB, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2017;4:CD001431.

    PubMed  Google Scholar 

  2. • Turkson-Ocran R-AN, Ogunwole SM, Hines AL, Peterson PN. Shared decision making in cardiovascular patient care to address cardiovascular disease disparities. J Am Heart Assoc. 2021;10:e018183. This paper lays the conceptual groundwork for understanding the importance of shared decision-making in cardiovascular care and particularly how it may be used to reduce existing disparities in outcomes. The authors present a framework linking social determinants of health, shared decision-making, and short- and long-term health outcomes, while also defining key constructs to be understood in this work.

  3. Backman WD, Levine SA, Wenger NK, Harold JG. Shared decision-making for older adults with cardiovascular disease. Clin Cardiol. 2020;43:196–204.

    Article  PubMed  Google Scholar 

  4. Chenel V, Mortenson WB, Guay M, Jutai JW, Auger C. Cultural adaptation and validation of patient decision aids: a scoping review. Patient Prefer Adherence. 2018;12:321–32.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Bazargan M, Cobb S, Assari S. Discrimination and medical mistrust in a racially and ethnically diverse sample of California adults. Ann Fam Med. 2021;19:4–15.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Veinot TC, Mitchell H, Ancker JS. Good intentions are not enough: how informatics interventions can worsen inequality. J Am Med Inform Assoc. 2018;25:1080–8.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Yen RW, Smith J, Engel J, Muscat DM, Smith SK, Mancini J, et al. A systematic review and meta-analysis of patient decision aids for socially disadvantaged populations: update from the International Patient Decision Aid Standards (IDPAS). Med Decis Making. 2021;41:870–96.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Elwyn G, Scholl I, Tietbohl C, Mann M, Edwards AGK, Clay C, et al. “Many miles to go …”: a systematic review of the implementation of patient decision support interventions into routine clinical practice. BMC Med Inform Decis Mak. 2013;13(Suppl 2):S14.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Lloyd A, Joseph-Williams N, Edwards A, Rix A, Elwyn G. Patchy, “coherence”: using normalization process theory to evaluate a multi-faceted shared decision making implementation program (MAGIC). Implement Sci. 2013;8:102.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Chung MK, Fagerlin A, Wang PJ, Ajayi TB, Allen LA, Baykaner T, et al. Shared decision making in cardiac electrophysiology procedures and arrhythmia management. Circ Arrhythm Electrophysiol. 2021;14:e007958.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Alden DL, Friend J, Lee PY, Lee YK, Trevena L, Ng CJ, et al. Who decides: me or we? Family involvement in medical decision making in eastern and western countries. Med Decis Making. 2018;38:14–25.

    Article  PubMed  Google Scholar 

  12. Durand M-A, Carpenter L, Dolan H, Bravo P, Mann M, Bunn F, et al. Do interventions designed to support shared decision-making reduce health inequalities? A systematic review and meta-analysis. PLoS ONE. 2014;9:e94670.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Thomas KL, Zimmer LO, Dai D, Al-Khatib SM, Allen LaPointe NM, Peterson ED. Educational videos to reduce racial disparities in ICD therapy via innovative designs (VIVID): a randomized clinical trial. Am Heart J. 2013;166:157–63.

    Article  PubMed  Google Scholar 

  14. Goyal P, Safford MM, Hilmer SN, Steinman MA, Matlock DD, Maurer MS, et al. N-of-1 trials to facilitate evidence-based deprescribing: rationale and case study. Br J Clin Pharmacol. 2022;88:4460–73.

    Article  PubMed  Google Scholar 

  15. Doll JA, Jones WS, Lokhnygina Y, Culpepper S, Parks RL, Calhoun C, et al. PREPARED study: a study of shared decision-making for coronary artery disease. Circ Cardiovasc Qual Outcomes. 2019;12:e005244.

    Article  PubMed  Google Scholar 

  16. Chhatriwalla AK, Decker C, Gialde E, Catley D, Goggin K, Jaschke K, et al. Developing and testing a personalized, evidence-based, shared decision-making tool for stent selection in percutaneous coronary intervention using a pre-post study design. Circ Cardiovasc Qual Outcomes. 2019;12:e005139.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Zhang D, Zhou Y, Liu J, Zhu L, Wu Q, Pan Y, et al. Application of patient decision aids in treatment selection of cardiac surgery patients: a scoping review. Heart Lung. 2022;56:76–85.

    Article  PubMed  Google Scholar 

  18. Anaya J, Moonsamy P, Sepucha KR, Axtell AL, Ivan S, Milford CE, et al. Pilot study of a patient decision aid for valve choices in surgical aortic valve replacement. Ann Thorac Surg. 2019;108:730–6.

    Article  PubMed  Google Scholar 

  19. Carroll SL, Stacey D, McGillion M, Healey JS, Foster G, Hutchings S, et al. Evaluating the feasibility of conducting a trial using a patient decision aid in implantable cardioverter defibrillator candidates: a randomized controlled feasibility trial. Pilot Feasibility Stud. 2017;3:49.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Rao BR, Merchant FM, Howard DH, Matlock D, Dickert NW. Shared decision-making for implantable cardioverter-defibrillators: policy goals, metrics, and challenges. J Law Med Ethics. 2021;49:622–9.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Vig EK, Pearlman RA. Good and bad dying from the perspective of terminally ill men. Arch Intern Med. 2004;164:977–81.

    Article  PubMed  Google Scholar 

  22. 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;30:2420–6.

    Article  PubMed  Google Scholar 

  23. Johnson AE, Bell YK, Hamm ME, Saba SF, Myaskovsky L. A Qualitative analysis of patient-related factors associated with implantable cardioverter defibrillator acceptance. Cardiol Ther. 2020;9:421–32.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Maddox TM, Song Y, Allen J, Chan PS, Khan A, Lee JJ, et al. Trends in U.S. Ambulatory Cardiovascular Care 2013 to 2017: JACC Review Topic of the Week. J Am Coll Cardiol. 2020;2020(75):93–112.

    Article  Google Scholar 

  25. Marzec LN, Wang J, Shah ND, Chan PS, Ting HH, Gosch KL, et al. Influence of direct oral anticoagulants on rates of oral anticoagulation for atrial fibrillation. J Am Coll Cardiol. 2017;69:2475–84.

    Article  CAS  PubMed  Google Scholar 

  26. Potpara TS, Mihajlovic M, Zec N, Marinkovic M, Kovacevic V, Simic J, et al. Self-reported treatment burden in patients with atrial fibrillation: quantification, major determinants, and implications for integrated holistic management of the arrhythmia. Europace. 2020;22:1788–97.

    Article  PubMed  Google Scholar 

  27. Coylewright M, Holmes DR Jr. Caution regarding government-mandated shared decision making for patients with atrial fibrillation. Circulation. 2017;135:2211–3.

    Article  PubMed  Google Scholar 

  28. Kunneman M, Branda ME, Noseworthy PA, Linzer M, Burnett B, Dick S, et al. Shared decision making for stroke prevention in atrial fibrillation: study protocol for a randomized controlled trial. Trials. 2017;18:443.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Kunneman M, Branda ME, Hargraves IG, Sivly AL, Lee AT, Gorr H, et al. Assessment of shared decision-making for stroke prevention in patients with atrial fibrillation: a randomized clinical trial. JAMA Intern Med. 2020;180:1215–24.

    Article  PubMed  Google Scholar 

  30. Mark DB, Anstrom KJ, Sheng S, Piccini JP, Baloch KN, Monahan KH, et al. Effect of catheter ablation vs medical therapy on quality of life among patients with atrial fibrillation: the CABANA Randomized Clinical Trial. JAMA. 2019;321:1275–85.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Schnabel RB, Pecen L, Rzayeva N, Lucerna M, Purmah Y, Ojeda FM, et al. Symptom burden of atrial fibrillation and its relation to interventions and outcome in Europe. J Am Heart Assoc. 2018. https://doi.org/10.1161/JAHA.117.007559.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Sultan A, Lüker J, Andresen D, Kuck KH, Hoffmann E, Brachmann J, et al. Predictors of atrial fibrillation recurrence after catheter ablation: data from the German Ablation Registry. Sci Rep. 2017;7:16678.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Reading Turchioe M, Mangal S, Ancker JS, Gwyn J, Varosy P, Slotwiner D. Replace uncertainty with information: shared decision-making and decision quality surrounding catheter ablation for atrial fibrillation. Eur J Cardiovasc Nurs. 2022. https://doi.org/10.1093/eurjcn/zvac078.

    Article  PubMed  Google Scholar 

  34. Seaburg L, Hess EP, Coylewright M, Ting HH, McLeod CJ, Montori VM. Shared decision making in atrial fibrillation: where we are and where we should be going. Circulation. 2014;129:704–10.

    Article  PubMed  Google Scholar 

  35. Ottawa Hospital Research Institute. Patient decision aids. Available from: https://www.healthwise.net/ohridecisionaid/Content/StdDocument.aspx?DOCHWID=zx3808. Cited 2023 June 9.

  36. Brodney S, Valentine KD, Sepucha K, Fowler FJ Jr, Barry MJ. Patient preference distribution for use of statin therapy. JAMA Netw Open. 2021;4:e210661.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Bacon E. Racial/ethnic differences in treatment recommendations: lifestyle changes and medication prescriptions for high cholesterol. Ethn Health. 2020;25:273–88.

    Article  PubMed  Google Scholar 

  38. Goyal P, Mangal S, Krishnaswami A, Rich MW. Polypharmacy in heart failure: progress but also problem. Am J Med. 2021:1071–1073.

  39. Unlu O, Levitan EB, Reshetnyak E, Kneifati-Hayek J, Diaz I, Archambault A, et al. Polypharmacy in older adults hospitalized for heart failure. Circ Heart Fail. 2020;13:e006977.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Alani Z. Exploring intersectionality: an international yet individual issue. Orphanet J Rare Dis. 2022;17:71.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Blair T, Microsoft. What is inclusive design? Available from: https://www.inclusivedesigntoolkit.com/whatis/whatis.html. Cited 2023 August 1.

  42. CDC. What is health literacy? In: Centers for Disease Control and Prevention [Internet]. 11 Jul 2023 [cited 1 Aug 2023]. Available: https://www.cdc.gov/healthliteracy/learn/index.html.

  43. Liu C, Wang D, Liu C, Jiang J, Wang X, Chen H, et al. What is the meaning of health literacy? A systematic review and qualitative synthesis. Fam Med Community Health. 2020. https://doi.org/10.1136/fmch-2020-000351.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Keates S. BS 7000-6:2005 Design management systems. Managing inclusive design. Guide. 2005 [cited 8 Jun 2023]. Available: http://gala.gre.ac.uk/id/eprint/12997/.

  45. The SHARE Approach—essential steps of shared decisionmaking: expanded reference guide with sample conversation starters. [cited 23 May 2023]. Available: https://www.ahrq.gov/health-literacy/professional-training/shared-decision/tool/resource-2.html.

  46. Coylewright M, Keevil JG, Xu K, Dodge SE, Frosch D, Field ME. Pragmatic study of clinician use of a personalized patient decision aid integrated into the electronic health record: an 8-year experience. Telemed J E Health. 2020;26:597–602.

    Article  PubMed  Google Scholar 

  47. Hickey KT, Masterson Creber RM, Reading M, Sciacca RR, Riga TC, Frulla AP, et al. Low health literacy: implications for managing cardiac patients in practice. Nurse Pract. 2018;43:49–55.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Rammstedt B, Danner D, Lechner C. Personality, competencies, and life outcomes: results from the German PIAAC longitudinal study. Large Scale Assess Educ. 2017. https://doi.org/10.1186/s40536-017-0035-9.

    Article  Google Scholar 

  49. •• Stacey D, Volk RJ, IPDAS Evidence Update Leads (Hilary Bekker, Karina Dahl Steffensen, Tammy C. Hoffmann, Kirsten McCaffery, Rachel Thompson, Richard Thomson, Lyndal Trevena, Trudy van der Weijden, and Holly Witteman). The International Patient Decision Aid Standards (IPDAS) collaboration: evidence update 2.0. Med Decis Making. 2021;41: 729–733. This paper presents an update by the International Patient Decision Aid Standards (IPDAS) Collaboration, detailing the latest evidence and advancements in patient decision aid standards aimed at improving medical decision-making processes.

  50. International Patient Decision Aid Standards (IPDAS) Collaboration. IPDAS 2005: Criteria for judging the quality of patient decision aids. Available from: http://ipdas.ohri.ca/ipdas_checklist.pdf.

  51. Mangal S, Niño de Rivera S, Choi J, Reading Turchioe M, Benda N, Sharko M, et al. Returning study results to research participants: data access, format, and sharing preferences. Int J Med Inform. 2023;170:104955.

    Article  PubMed  Google Scholar 

  52. Ancker JS, Benda NC, Sharma MM, Johnson SB, Weiner S, Zikmund-Fisher BJ. Taxonomies for synthesizing the evidence on communicating numbers in health: goals, format, and structure. Risk Anal. 2022;42:2656–70.

    Article  PubMed  Google Scholar 

  53. Bonner C, Trevena LJ, Gaissmaier W, Han PKJ, Okan Y, Ozanne E, et al. Current best practice for presenting probabilities in patient decision aids: fundamental principles. Med Decis Making. 2021;41:821–33.

    Article  PubMed  Google Scholar 

  54. Trevena LJ, Bonner C, Okan Y, Peters E, Gaissmaier W, Han PKJ, et al. Current challenges when using numbers in patient decision aids: advanced concepts. Med Decis Making. 2021;41:834–47.

    Article  PubMed  Google Scholar 

  55. Barksdale CL, Rodick WH III, Hopson R, Kenyon J, Green K, Jacobs CG. Literature review of the National CLAS Standards: policy and practical implications in reducing health disparities. J Racial Ethn Health Disparities. 2017;4:632–47.

    Article  PubMed  Google Scholar 

  56. Alden DL, Friend J, Schapira M, Stiggelbout A. Cultural targeting and tailoring of shared decision making technology: a theoretical framework for improving the effectiveness of patient decision aids in culturally diverse groups. Soc Sci Med. 2014;105:1–8.

    Article  PubMed  Google Scholar 

  57. Uskul AK, Oyserman D. When message-frame fits salient cultural-frame, messages feel more persuasive. Psychol Health. 2010;25:321–37.

    Article  PubMed  Google Scholar 

  58. Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol. 2000;55:68–78.

    Article  CAS  PubMed  Google Scholar 

  59. Mischel W. Toward an integrative science of the person. Annu Rev Psychol. 2004;55:1–22.

    Article  PubMed  Google Scholar 

  60. Mischel W, Shoda Y. A cognitive-affective system theory of personality: reconceptualizing situations, dispositions, dynamics, and invariance in personality structure. Psychol Rev. 1995;102:246–68.

    Article  CAS  PubMed  Google Scholar 

  61. Oyserman D, Sorensen N, Reber R, Chen SX. Connecting and separating mind-sets: culture as situated cognition. J Pers Soc Psychol. 2009;97:217–35.

    Article  PubMed  Google Scholar 

  62. Kitayama S, Park H, Sevincer AT, Karasawa M, Uskul AK. A cultural task analysis of implicit independence: comparing North America, Western Europe, and East Asia. J Pers Soc Psychol. 2009;97:236–55.

    Article  PubMed  Google Scholar 

  63. Vogels EA. Digital divide persists even as Americans with lower incomes make gains in tech adoption. In: Pew Research Center [Internet]. 22 Jun 2021 [cited 7 Jun 2023]. Available: https://www.pewresearch.org/short-reads/2021/06/22/digital-divide-persists-even-as-americans-with-lower-incomes-make-gains-in-tech-adoption/.

  64. Muscat DM, Smith J, Mac O, Cadet T, Giguere A, Housten AJ, et al. Addressing health literacy in patient decision aids: an update from the international patient decision aid standards. Med Decis Making. 2021;41:848–69.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Witteman HO, Maki KG, Vaisson G, Finderup J, Lewis KB, Dahl Steffensen K, et al. Systematic development of patient decision aids: an update from the IPDAS collaboration. Med Decis Making. 2021;41:736–54.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Rahn AC, Jull J, Boland L, Finderup J, Loiselle M-C, Smith M, et al. Guidance and/or decision coaching with patient decision aids: scoping reviews to inform the International Patient Decision Aid Standards (IPDAS). Med Decis Making. 2021;41:938–53.

    Article  PubMed  Google Scholar 

  67. Hargraves IG, Fournier AK, Montori VM, Bierman AS. Generalized shared decision making approaches and patient problems. Adapting AHRQ’s SHARE Approach for Purposeful SDM. Patient Educ Couns. 2020;103:2192–9.

    Article  PubMed  PubMed Central  Google Scholar 

  68. ACP. How to promote health equity with patient decision aids - advance care planning (ACP) decisions. In: Advance care planning (ACP) decisions [internet]. 16 May 2022 [cited 23 May 2023]. Available: https://www.acpdecisions.org/spotlight-on-vulnerable-populations-using-patient-decision-aids-to-promote-healthcare-equity/.

  69. Zeballos-Palacios C, LeBlanc A, Hess EP, Tilburt J, Wyatt K, Boehmer K, et al. Case study: interventions to create better conversations at the Mayo Clinic. Oxford University Press; 2016.

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Funding

Dr. Masterson Creber is funded by R01HL161458, R01NS123639, and R01HL152021. Dr. Benda is funded by R00MD015781. Dr. Reading Turchioe is funded by R00NR019124.

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Authors and Affiliations

  1. Columbia University School of Nursing, Columbia University Irving Medical Center, 560 W 168th St, New York, NY, 10032, USA

    Ruth Masterson Creber, Natalie Benda, Arnaldo Dimagli, Annie Myers, Stephanie Niño de Rivera, Shalom Omollo, Yashika Sharma & Meghan Reading Turchioe

  2. Weill Cornell Medicine, New York, NY, USA

    Parag Goyal

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  1. Ruth Masterson Creber
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Correspondence to Ruth Masterson Creber.

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Dr. Reading Turchioe reports consulting fees from Boston Scientific and equity in Iris OB Health. The other authors confirm that there is no conflict of interest.

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Masterson Creber, R., Benda, N., Dimagli, A. et al. Using Patient Decision Aids for Cardiology Care in Diverse Populations. Curr Cardiol Rep 25, 1543–1553 (2023). https://doi.org/10.1007/s11886-023-01953-z

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