Fatima Ali-Ahmed1,2, Daniel Matlock3, Emily P Zeitler4, Kevin L Thomas1,5, David E Haines2, Sana M Al-Khatib1,5. 1. Duke Clinical Research Institute, Durham, North Carolina. 2. Division of Cardiology, Beaumont Health, Michigan. 3. Division of Geriatric Medicine, University of Colorado School of Medicine, Aurora, Colorado. 4. Division of Cardiology, Dartmouth-Hitchcock Medical Center and Geisel School of Medicine, Dartmouth, Lebanon, New Hampshire. 5. Division of Cardiology, Duke University Medical Center, Durham, North Carolina.
Abstract
BACKGROUND: Centers for Medicare and Medicaid Services has mandated the use of shared decision-making (SDM) for implantable cardioverter-defibrillator (ICD) implantation. SDM tools help facilitate quality SDM by presenting patients with balanced evidence-based facts related to risk and benefits. Perceptions of ICD implantation may differ based on patients' sex and race. OBJECTIVE: To determine if and how physicians are incorporating SDM in counseling patients about ICD and if they are aware of sex- and race-based differences in patients' perception of ICDs. METHODS: This was a pilot study involving an online survey targeting attending physicians who implant ICDs. Physicians were randomly selected by a computer-based program; 350 surveys were sent. RESULTS: Of the 124 (35%) respondents to the survey, 102 (84%) met the inclusion criteria, and of those, 99 (97%) were adult electrophysiologists. Most physicians (90, 88%) stated they engaged in SDM during the general consent process. Sixty-three (62%) physicians discuss end of life issues while obtaining general consent. Forty-four (43%) physicians said they use an existing SDM tool with the Colorado SDM tool being the most common (39, 89%). The majority of physicians were unaware of sex- and race-based differences in perceptions related to ICD implantation (sex 64, 63% and race 63, 62%). CONCLUSION: A vast majority of physicians are engaging in SDM; however less than half are using a formal SDM tool, and a minority of physicians were aware of sex- and race-based differences in patients' perception of ICD implantation. Sex- and race-based tools might help address this gap.
BACKGROUND: Centers for Medicare and Medicaid Services has mandated the use of shared decision-making (SDM) for implantable cardioverter-defibrillator (ICD) implantation. SDM tools help facilitate quality SDM by presenting patients with balanced evidence-based facts related to risk and benefits. Perceptions of ICD implantation may differ based on patients' sex and race. OBJECTIVE: To determine if and how physicians are incorporating SDM in counseling patients about ICD and if they are aware of sex- and race-based differences in patients' perception of ICDs. METHODS: This was a pilot study involving an online survey targeting attending physicians who implant ICDs. Physicians were randomly selected by a computer-based program; 350 surveys were sent. RESULTS: Of the 124 (35%) respondents to the survey, 102 (84%) met the inclusion criteria, and of those, 99 (97%) were adult electrophysiologists. Most physicians (90, 88%) stated they engaged in SDM during the general consent process. Sixty-three (62%) physicians discuss end of life issues while obtaining general consent. Forty-four (43%) physicians said they use an existing SDM tool with the Colorado SDM tool being the most common (39, 89%). The majority of physicians were unaware of sex- and race-based differences in perceptions related to ICD implantation (sex 64, 63% and race 63, 62%). CONCLUSION: A vast majority of physicians are engaging in SDM; however less than half are using a formal SDM tool, and a minority of physicians were aware of sex- and race-based differences in patients' perception of ICD implantation. Sex- and race-based tools might help address this gap.
Authors: Mina K Chung; Angela Fagerlin; Paul J Wang; Tinuola B Ajayi; Larry A Allen; Tina Baykaner; Emelia J Benjamin; Megan Branda; Kerri L Cavanaugh; Lin Y Chen; George H Crossley; Rebecca K Delaney; Lee L Eckhardt; Kathleen L Grady; Ian G Hargraves; Mellanie True Hills; Matthew M Kalscheur; Daniel B Kramer; Marleen Kunneman; Rachel Lampert; Aisha T Langford; Krystina B Lewis; Ying Lu; John M Mandrola; Kathryn Martinez; Daniel D Matlock; Sarah R McCarthy; Victor M Montori; Peter A Noseworthy; Kate M Orland; Elissa Ozanne; Rod Passman; Krishna Pundi; Dan M Roden; Elizabeth V Saarel; Monika M Schmidt; Samuel F Sears; Dawn Stacey; Randall S Stafford; Benjamin A Steinberg; Sojin Youn Wass; Jennifer M Wright Journal: Circ Arrhythm Electrophysiol Date: 2021-12-06
Authors: Katherine C Wu; Hiroshi Ashikaga; Julian Krebs; Tommaso Mansi; Hervé Delingette; Bin Lou; Joao A C Lima; Susumu Tao; Luisa A Ciuffo; Sanaz Norgard; Barbara Butcher; Wei H Lee; Ela Chamera; Timm-Michael Dickfeld; Michael Stillabower; Joseph E Marine; Robert G Weiss; Gordon F Tomaselli; Henry Halperin Journal: Sci Rep Date: 2021-11-22 Impact factor: 4.996