This Heart Health Month, we highlight leading research that explores why a culture shift is needed within cardiac care in B.C.
New research is shifting care toward greater patient inclusion in discussions surrounding their treatment plans. In her recent Canadian Journal of Cardiology study, Vancouver Coastal Health Research Institute researcher Dr. Sandra Lauck discusses the shared decision-making (SDM) framework — an internationally recognized health care best practice — as an underutilized essential component in valvular heart disease care.
“High-quality SDM conversations involving discussions about patient priorities and values have been solidified in international guidelines, such as those of the Canadian Cardiovascular Society and American Heart Association/American College of Cardiology, including for valvular heart disease management,” states Lauck.
Beyond informed consent, the concept of SDM is about clinicians and patients engaging in meaningful, bidirectional discussions about treatment options, Lauck adds.
"Evidence underscores that SDM significantly improves patients’ experiences of care and reduces decisional regret — that feeling of not having made the right choice about their care. Without taking a lot more time for health care providers, it enhances clinical practices and can contribute to improved health services.”
Valvular heart disease is a condition in which the valves that pump blood through the heart become weakened or restricted. These conditions can lead to serious symptoms, such as difficulty breathing, fever, chest pain, dizziness, an irregular heartbeat or fatigue, and death. Valvular heart disease can occur at any age, but mostly affects older adults. In addition, recent studies indicate that the condition is on the rise globally.
Lauck’s research — developed with a team of co-investigators that include patient partners and organizations that support heart patient care — is a deep-dive into the benefits of SDM to generate high-quality, clinician-patient conversations on different treatment options for valvular heart disease.
Research guidelines close the gap on moving process into clinical practice
Lauck’s study — and subsequent editorial in the British Medical Journal publication Heart and contribution to an SDM roadmap for patient organizations, patient advocates and health care professionals — sets the stage for the development of tailored plans for SDM implementation. The SDM roadmap is not a one-size-fits all approach, but rather a foundation upon which to design SDM implementation plans for different care settings and patient populations.
“The fact is that, despite the body of evidence supporting the use of SDM in clinical practice, there is no official roadmap for its efficient and sustained implementation.”
“There is currently inconsistent implementation of SDM in clinical practice,” states Lauck. “While many physicians report having open discussions with their patients about care options, others are concerned that SDM engagement would consume precious time during patient appointments. However, instead of a unidirectional approach in which the physician directs a patient towards a particular treatment plan, SDM is a conversation with a patient about their values, along with treatment options that best align with those values.”
A patient in need of a heart valve replacement or repair who is also the primary homecare provider for their partner may opt for a valve replacement procedure with the fastest recovery time, shares Lauck.
“A good outcome is not only about treatment effectiveness, but also about whether a patient feels that their values and viewpoints have been heard by their doctor and their heart team.”
Lauck’s research suggests that patient-reported outcomes measurements (PROMs) be incorporated when evaluating the application of SDM in care settings. PROM is a standardized form of data collection that captures a snapshot of a patient’s view of their health status.
Gaps in SDM interactions may be filled with additional teaching tools, such as educational videos of treatment options for valvular heart care, Zoom meetings, printed information sheets and more.
“We know that when we invite patients into their care decision-making process, when we measure quality of life outcomes, such as PROM, we end up with better patient experiences and overall patient outcomes,” states Lauck.
“SDM is something that we need to do, and whenever we need to do something in health care, we usually get it done.”
