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041 Interventions of shared decision making in coronary artery disease: a scoping review
  1. Ann Cheng1,
  2. Ali Alhashimi2,
  3. Yuen Kiu Tai2,
  4. Thanusya Thatparan2,
  5. Roocha Odedra2,
  6. Gavin J Murphy1
  1. 1Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
  2. 2School of Medicine and Population Health, University of Sheffield, Sheffield, UK

Abstract

Introduction Coronary artery disease (CAD) affects 200 million people globally. Management is often complex and guidelines increasingly emphasize shared decision making and a patient-centered approach. The purpose of this study was to identify all interventions of shared decision making for patients with CAD.

Methods A scoping review was prospectively registered (https://doi.org/10.17605/OSF.IO/3P46Z). MEDLINE, CINAHL, EMBASE, Google Scholar, PsycInfo, ClinicalTrials.gov and ICTRP were searched from inception to September 2023. No restrictions were imposed on study design or publication year. Data was independently screened, extracted and analyzed, with a focus on decision aid design and study outcomes.

Results Eighteen studies were identified describing a total of 16 decision aids (DA) between 1996 and 2023. Print was the most common format. Other formats included digital, nurse-led educational visits, group visits, and decision coaches. Most DAs pertained to revascularization options for CAD, including percutaneous coronary intervention, coronary artery bypass grafting and optimal medical treatment. The most commonly reported outcomes were improved patient knowledge, increased engagement, reduced decisional conflict, improved confidence, but no difference in treatment concordance, patient satisfaction, or preference shift.

Discussion The included studies have highlighted several key points. Firstly, DAs do not have to be used in isolation; a combination of print, group visit, and provider training is feasible. Secondly, there appears to be no difference in treatment concordance despite increased patient knowledge and engagement, suggesting a potential influence of personal preference and an imbalance in physician-patient dynamic. Thirdly, implementation challenges such as resource availability, recruitment and timing of DA implementation need to be carefully considered. Finally, the option for no treatment needs to be recognized.

Conclusion DAs exist as a useful tool to promote shared decision making in CAD. Healthcare professionals should incorporate DAs as a tool for shared decision making into clinical practice, particularly around revascularization options.

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