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Shared Decision Making and Effective Communication in Heart Failure-Moving from "Code Status" to Decisional Readiness
Caroline McGuinty1, James Downar2, Michael Slawnych3
1University of Ottawa Heart Institute, Division of Cardiology, University of Ottawa, Ottawa, Ontario, Canada.
The Canadian Journal of Cardiology
|December 29, 2020
Summary
Timely discussions about prognosis and goals of care are crucial for heart failure (HF) patients. Shared decision-making (SDM) empowers patients and families for critical treatment choices during acute decompensation.
Area of Science:
- Cardiology
- Palliative Care
- Medical Ethics
Background:
- Heart failure (HF) is a progressive, terminal disease despite treatment advances.
- Current practices often delay essential prognosis and goals-of-care discussions.
- Professional societies and policy highlight the need for timely conversations.
Purpose of the Study:
- To emphasize the importance of shared decision-making (SDM) in heart failure management.
- To advocate for proactive discussions about disease trajectory, prognosis, and patient values.
- To prepare patients and families for immediate treatment decisions during acute events.
Main Methods:
- Focus on understanding disease progression and prognostic uncertainty.
- Incorporate patient values, goals, and preferences into treatment planning.
- Integrate discussions on risks of mortality and quality-of-life impacts.
Main Results:
- SDM aligns treatment decisions with patient-centered goals.
- Acknowledging prognostic uncertainty is key to effective communication.
- Discussions should prepare for "in-the-moment" decisions, not just future planning.
Conclusions:
- Proactive, value-based discussions are essential for heart failure care.
- Shared decision-making enhances patient preparedness for acute decompensation.
- Integrating prognosis and goals-of-care discussions improves patient outcomes and quality of life.
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