Shared decision-making for older adults with cardiovascular disease

• Type of Material: Article
• Authors: Warren D. Backman, Veteran Affairs New England; Sharon A. Levine, Massachusetts General Hospital; Nanette Wenger, Emory University; John Gordon Harold, Cedars Sinai Smidt Heart Institute
• Language: English
• Date: 2019-10-03
• Publisher: WILEY
• Publication Version: Final Published Version
• Copyright Statement: © 2019 The Authors. Clinical Cardiology published by Wiley Periodicals, Inc.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1002/clc.23267
• Title of Journal or Parent Work: CLINICAL CARDIOLOGY
• Volume: 43
• Issue: 2
• Start Page: 196
• End Page: 204
• Keywords: decision-making capacity; Life Sciences & Biomedicine; Science & Technology; Cardiovascular System & Cardiology; IMPACT; cardiovascular disease; decision aids; patient centered care; clinical decision-making; geriatric cardiology; Cardiac & Cardiovascular Systems; PATIENTS CAPACITIES; HEARING-LOSS; aged; elderly; CARE; shared decision-making; older adults; HEALTH; SCIENTIFIC STATEMENT; COGNITIVE IMPAIRMENT; informed decision-making; geriatrics
• Research Categories: Health Sciences, Medicine and Surgery; Gerontology

Abstract

Shared decision-making is appropriate for clinical decisions involving multiple reasonable options, which occur frequently in the cardiovascular care of older adults. The process includes the communication of relevant factual information between the patient and the clinician, elicitation of patient preferences, and a mutual agreement on the best course of action to meet the patient's personal goals. For older adults, there are common challenges and considerations with regard to shared decision-making, some of which (eg, cognitive impairment) may be biologically linked to cardiovascular disease. There are tools designed to facilitate the shared decision-making process, known as decision aids, which are broadly effective although have shortcomings when applied to older adults. Novel approaches in clinical research and health systems changes will go some way toward improving shared decision-making for older adults, but the greatest scope for improvement may be within the grass roots areas of communication skills, interdisciplinary teamwork, and simply asking our patients what matters most.