March 6th, 2012
Shared Decision Making in Advanced Heart Failure
Larry Allen is the lead author and co-chair of the AHA Scientific Statement on Decision Making in Advanced Heart Failure.
Patient-centered care ensures that clinical decisions are guided by an individual patient’s values, needs, and preferences; shared decision making is the act of putting this type of care into clinical practice by asking health care providers and patients to consider information together and work toward consensus. This process should focus on the outcomes that are most important to the patients, including not only survival but also relief of symptoms, quality of life, and living at home.
High-quality medical decision making for advanced heart failure is becoming particularly important but also increasingly challenging as patients are living longer with their heart disease and treatment options continue to expand– including left ventricular assist devices. Therefore, the American Heart Association has sponsored a Scientific Statement entitled “Decision Making in Advanced Heart Failure, published yesterday, that provides a roadmap for clinicians caring for these complex patients. The statement argues that for patients with advanced heart failure, the decision-making process should be proactive, anticipatory, and patient-centered. This involves talking about goals of care, expectations for the future, and the full range of treatment options, including palliative care. It also requires a team approach.
As the time required for shared decision making is difficult to fit into a regular clinic visit in the middle of a busy clinical practice, we propose an annual review to discuss prognosis, consider reasonable therapies, and clarify the patient’s values, goals and preferences. This review is in addition to, not a replacement for, additional discussions triggered by events such as hospitalizations and other changes in the patient’s health.