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THE ROLE OF SHARED DECISION-MAKING IN LAAC PROCEDURES1


  • A formal shared decision-making interaction with an independent non-interventional physician using an evidence-based decision tool is recommended for oral anticoagulation in patients with non-valvular atrial fibrillation (NVAF) prior to LAAC
    • The shared decision-making interaction must also be documented in the medical record
  • The patient must be suitable for short-term warfarin but deemed unable to take long-term oral anticoagulation following the conclusion of shared decision-making, as LAAC is only covered as a second-line therapy to oral anticoagulants 

HOW SHARED DECISION-MAKING WORKS2


  • In clinical scenarios characterized by more than one viable treatment or screening option, providers can facilitate shared decision-making by:
    • Encouraging patients to communicate what they care about
    • Providing decision aids that raise the patient’s awareness and understanding of treatment options and possible outcomes

IMPLEMENTING SHARED DECISION-MAKING IN CLINICAL PRACTICE:


THE AGENCY FOR HEALTHCARE RESEARCH AND QUALITY'S SHARE APPROACH3

 

AHRQ’s SHARE Approach is a five-step shared decision-making process that compares the benefits and risks of each option through meaningful dialogue about what matters most to the patient


Step 1: Seek your patient's participation

Step 2: Help your patient explore and compare treatment options

Step 3: Assess your patient's values and preferences

Step 4: Reach a decision with your patient

Step 5: Evaluate your patient's decision

PLANNING FOR POSITIVE OUTCOMES


  • Patient-provider discussions may uncover barriers to change that include physical pain, emotional difficulties, financial concerns, and lack of confidence in one’s ability to change
    • These and other barriers can then be addressed so that a realistic personal prevention plan is formulated with specific and achievable outcomes

SHARED DECISION-MAKING RESOURCES


NICE Patient Decision Aid

Note: CMS advises that, due to a lack of an evidence-based tool for LAAC decision-making, the inclusion of a multidisciplinary team to support shared decision-making will enhance more informed patient decision-making.   

 

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