What are the experiences of patients and professionals of sharing decisions about starting statins for the prevention of cardiovascular disease? A qualitative evidence synthesis.

Talk Code: 
EP3E.02
Presenter: 
Rachel Johnson
Co-authors: 
Rachel Johnson, Kingsley Powell, Matthew Ridd
Author institutions: 
University of Bristol

Problem

Shared decision making is a process by which clinicians and patients make healthcare decisions together, and has been promoted as a marker of quality healthcare. However, shared decision making has proved challenging to implement in routine practice. Clinicians and patients commonly face a decision about starting HMG CoA reductase inhibitors (statins) for the prevention of cardiovascular disease, as recommended by national United Kingdom guidance. Shared decision making has been particularly advocated for this decision, however, little is known about how decisions are currently made in clinical settings. In-depth exploration of the experiences of healthcare professionals and patients in making decisions about statins can inform understanding of how shared decision making for statin decisions can be supported.

Approach

A review and synthesis of qualitative studies examining the experiences of patients and healthcare professionals of taking part in decisions about starting statin therapy. Systematic searches in electronic databases were followed by dual title and abstract screening and subsequent full text screening against inclusion criteria. Thematic synthesis was undertaken: data was coded and organised into descriptive themes; themes were translated across studies, synthesised and represented as analytic themes.

Findings

Of 2186 articles screened by title and abstract, 13 articles were included in the synthesis, of which 11 were based in primary care. Healthcare professional and patient views were described in 9 studies each. Descriptive thematic analysis identified four themes: how clinicians choose what information to share; understanding and communicating cardiovascular risk; the role of the patient in decision making; and the role of the clinician in decision making. Clinicians engaged in complex processes in choosing what information and options to share with patients and how to share them; patient contributions to this process were thinly described. Patients showed limited understanding of cardiovascular risk, particularly in relation to making decisions about statins. Clinicians and patients reported varied decision making roles from paternalistic to informed decision making. Patients typically described clinicians as expert, and tended to defer to the clinician to make the final decision. Decision aids supported patient involvement in the consultation, but largely supported existing decision making roles.

Consequences

Clinicians need to be aware of the process by which they decide which options to share with patients, and how to share them. These choices may be influenced by the preferences and values of patients and should not be assumed. Clinicians’ decision making roles vary in the degree to which management options are presented as choices or imperatives. Clinicians should be aware of that patients tend to defer to clinician’s expertise and consider how they framing choices. Further exploration of how patients’ preferences and values can influence these processes is warranted.

Submitted by: 
Rachel Johnson
Funding acknowledgement: 
Rachel Johnson is funded by an NIHR doctoral fellowship.