May 28, 2013
Decision-Making Preferences Among Patients With Heart Attacks
In a research letter, Harlan M. Krumholz, M.D., S.M., from Yale University School of Medicine and colleagues, "sought to investigate preferences for participation in the decision-making process among individuals hospitalized with an acute myocardial infarction ([AMI] or heart attack)." The researchers combined data from two similar AMI registries (TRIUMPH and PREMIER) which resulted in 6,636 patients in the study sample who were asked about who should make decisions on treatment options.
"More than two-thirds of patients with AMI indicated a preference to play an active role in the decision-making process, and of those, about a quarter preferred that the decision be theirs alone rather than shared with their physician," the authors found. "Our findings indicate that physicians who aspire to provide patient-centered care should assess patients' decision-making preferences by directly asking each patient."
"Our challenge now is to develop systems that fully respect these preferences and ensure that patients who prefer an active role are given that opportunity," the authors conclude.
Commentary: Shared Decision Making
In an invited commentary, Mack Lipkin, M.D., from NYU Langone School of Medicine, New York City, reviews several of the studies being published online by JAMA Internal Medicine on this topic. Lipkin writes that "shared decision making in the modern era began as informed decision making, a reverse reification of informed consent promulgated in President Reagan's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research."
"I believe a series of prospective studies is needed, starting with taped interviews, to validate current notions of what embodies SDM (shared decision-making), to establish how framing and contextual features alter recollections, and to relate accurately and validly measured strong and weak SDM to the evolution of recalled views about the decisional process. Such results could then be related to health outcomes."
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