Facilitating Shared Decision Making Among Black Patients at Risk for Sudden Cardiac Arrest : A Randomized Clinical...

Area of Science:

• Cardiology
• Health Disparities
• Medical Decision Making

Background:

• Racial disparities exist in implantable cardioverter-defibrillator (ICD) implantation rates.
• Higher patient refusal rates contribute to these disparities.
• Black patients eligible for ICDs represent a population where decision-making interventions may be beneficial.

Purpose of the Study:

• To evaluate the effectiveness of a video decision support tool for Black patients eligible for primary prevention ICD implantation.
• To assess the tool's impact on patient knowledge, decisional conflict, and implantation rates.

Main Methods:

• A multicenter, randomized clinical trial involving Black adults with heart failure eligible for primary prevention ICDs.
• Participants received either an encounter-based video decision support tool or usual care.
• Outcomes included decision regarding ICD implantation, patient knowledge, decisional conflict, and implantation rates within 90 days.

Main Results:

• The video tool did not significantly alter assent to ICD implantation (58.6% vs. 59.4%).
• Participants using the video tool showed improved knowledge scores but similar decisional conflict.
• ICD implantation rates within 90 days were comparable between groups.
• Patients receiving the video tool spent less time with clinicians.

Conclusions:

• A video-based decision support tool can enhance patient knowledge regarding ICDs.
• The tool did not increase patient assent for ICD implantation in this population.
• Further strategies are needed to address racial disparities in ICD decision-making.