Toward Optimal Decision Making among Vulnerable Patients Referred for Cardiac Surgery: A Qualitative Analysis of Patient and Provider Perspectives

Gainer, Ryan; Curran, Janet; Buth, Karen J.; David, Jennie; Légaré, Jean‐François; Hirsch, Gregory M.

doi:10.1177/0272989x16675338

Cited by 38 publications

(52 citation statements)

References 25 publications

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“…These findings have been observed in both cardiac and noncardiac patient populations wherein the development of decision aids or the implementation of a decisional ''coach'' has been advocated to facilitate a shared-decision making process in patients with chronic conditions facing decisions involving invasive, preference-sensitive therapy options. 28 As stated by Gainer and colleagues, 27 given ''.the trend toward older and frail patients referred for complex cardiac procedures, the need for an effective shared decision making process is compelling.'' for the modern perioperative cardiac surgery team.…”

Section: An Economic Argumentmentioning

confidence: 99%

Frailty as a risk predictor in cardiac surgery: Beyond the eyeball test

Yanagawa

Graham

Afilalo

et al. 2018

The Journal of Thoracic and Cardiovascular Surgery

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Section: An Economic Argumentmentioning

confidence: 99%

Frailty as a risk predictor in cardiac surgery: Beyond the eyeball test

Yanagawa

Graham

Afilalo

et al. 2018

The Journal of Thoracic and Cardiovascular Surgery

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“…The use of a decisional coach into the process of care is another strategy to improve the decision making practices. The decisional coach would be someone (e.g., a nurse) who could understand patient-specific values and goals of care, and relay issues to physicians in preparation for the patient-physician encounter [33].…”

Section: Summary Of Evidencementioning

confidence: 99%

Patients’ Involvement in Decision Making at End of Life—A Systematic Review of Literature

Othman¹,

Khalaf²,

Zeilani³

2019

OJN

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Background: involving patient in end of life decision is important to understand their wishes and preference, which will help health care providers in improving the quality of dying and minimizing suffering. Aim: the aim of this review was to provide a detailed examination of the available literature related to patients' involvement in decision making at end of life. Design: a systematic review following the PRISMA protocol was used, the review protocol was registered on PROSPERO: CRD42019128556. Data sources: we conducted a literature search in two electronic databases "CINAHL and Medline" during March-April 2019. The retrieved articles were included if they were: research reports or literature review; examined patient involvement in end of life discussions; full text publications, written in English and published from 2000-2019. Results: a total of (22) articles were included in the review; there was diversity in the purposes and design approach of the retrieved studies. The available literature explored patient's involvement at end of life decision making through; describing current practices; understanding perspectives of end of life discussions; investigating the impact and identifying the barriers and facilitators of patients' involvement in end of life discussions. Conclusion: involvement in end of life discussions improved the recognition of patients' wishes, improved death experience, and decreased posttraumatic stress, depression, and anxiety among family members. Despite the documented benefits, some barriers against patient's involvement in EOL decisions were recognized; lack of awareness; lack of education, training and experience; concerns about ethical and legal issues; and personal preferences of doctors or nurses were among the most commonly identified barriers.

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“…Despite recommendations in professional guidelines3 4 6 and expanding knowledge of SDM, the current experience with SDM in older patients with SSAS seems limited. Given the expected increase in the number of older patients referred for complex cardiac procedures, the need for an appropriate and individual tailored decision making process is compelling 14. The objective of this study is to provide an overview of the status of SDM in the treatment of older patients with SSAS and to review to what extent the domains of SDM are incorporated in the current treatment practice of SSAS.…”

Section: Introductionmentioning

confidence: 99%

Shared decision making in older patients with symptomatic severe aortic stenosis: a systematic review

Beek-Peeters

Noort

Faes

et al. 2020

Heart

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This review provides an overview of the status of shared decision making (SDM) in older patients regarding treatment of symptomatic severe aortic stenosis (SSAS). The databases Embase, Medline Ovid, Cinahl and Cochrane Dare were searched for relevant studies from January 2002 to May 2018 regarding perspectives of professionals, patients and caregivers; aspects of decision making; type of decision making; application of the six domains of SDM; barriers to and facilitators of SDM. The systematic search yielded 1842 articles, 15 studies were included. Experiences of professionals and informal caregivers with SDM were scarcely found. Patient refusal was a frequently reported result of decision making, but often no insight was given into the decision process. Most studies investigated the ‘decision’ and ‘option’ domains of SDM, yet no study took all six domains into account. Problem analysis, personalised treatment aims, use of decision aids and integrating patient goals in decisions lacked in all studies. Barriers to and facilitators of SDM were ‘individualised formal and informal information support’ and ‘patients’ opportunity to use their own knowledge about their health condition and preferences for SDM’. In conclusion, SDM is not yet common practice in the decision making process of older patients with SSAS. Moreover, the six domains of SDM are not often applied in this process. More knowledge is needed about the implementation of SDM in the context of SSAS treatment and how to involve patients, professionals and informal caregivers.

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Toward Optimal Decision Making among Vulnerable Patients Referred for Cardiac Surgery: A Qualitative Analysis of Patient and Provider Perspectives

Cited by 38 publications

References 25 publications

Frailty as a risk predictor in cardiac surgery: Beyond the eyeball test

Frailty as a risk predictor in cardiac surgery: Beyond the eyeball test

Patients’ Involvement in Decision Making at End of Life—A Systematic Review of Literature

Shared decision making in older patients with symptomatic severe aortic stenosis: a systematic review

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