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Shared decision-making is not common in clinical practice
  1. Yvonne Schoon
  1. Geriatrics, Radboud University Nijmegen, Nijmegen, The Netherlands
  1. Correspondence to Dr Yvonne Schoon, Geriatrics, Radboud University Nijmegen, Nijmegen, Gelderland, The Netherlands; yvonne.schoon{at}

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Shared decision-making (SDM) is accepted as an important element in improving the quality of patient care and treatment. Although healthcare professionals believe that they incorporate SDM in their daily clinical practice, the evidence proves otherwise. In evaluating cardiac treatment options, physicians generally focus on treatment complications and survival as the main outcomes.

Currently, healthcare professionals are still insufficiently trained in SDM, healthcare guidelines do not provide any indications for SDM, disease-specific guidelines often lack decision-making aids, and SDM outcomes are not systematically incorporated in an evaluation to improve the quality of healthcare.

SDM is defined as ‘a collaborative process that allows patients, relatives and clinicians to make healthcare decisions together, considering the best scientific evidence available, as well as the patient’s values, goals, and preferences’.

SDM is grounded on the ethical principles of individual self-determination and respect for autonomy. In addition to an ethical motive, SDM is also associated with benefits such as increased knowledge, more accurate risk perception, increased satisfaction with the decision and improved long-term health-related quality of life.1 Although its importance has been largely supported, the application of SDM in routine cardiac care is still limited. In addition, current SDM models for clinical practice and decision-making aids that encourage patient participation in decision-making lack focus on older patients.1 2

SDM is particularly appropriate in preferential decision-making, such as in-treatment decision-making for older patients with cardiovascular disease, for whom alternatives for major surgery are available, for example, non-surgical invasive therapy (such as transcatheter aortic valve replacement) or conservative therapy. Cardiac disease is the second leading cause of morbidity and mortality worldwide. Due to the ageing population and increasing heterogeneity and concomitant multimorbidity, the (surgical) evaluations of these patients have become more complex. Treatment considerations should balance survival, risk of short-term complications and long-term adverse outcomes, such …

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  • Contributors YS is the sole contributor.

  • Funding The author has not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Commissioned; internally peer reviewed.

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