Shared decisions, evaluate to advance

Jordi Varela

Editor

The progress of shared clinical decisions is being almost negligible and, for this reason, attention should be paid to the results of the clinical trial by Víctor Montori's research group, an evaluation that was carried out with almost a thousand patients with atrial fibrillation. which ones had to decide if they wanted to take anticoagulants and, if they did, which one they would choose. In the trial, the intervention group of patients tested a shared decision support instrument, while the control group followed the usual clinical pathway.

An algorithm to help patients decide if they want to take blood thinners

To Anticoagulation Choice Decision Aid, Mayo Clinic offers an algorithm that aims to facilitate the understanding of risks for patients to generate a climate of shared decisions. To illustrate the characteristics of the instrument, I suggest imagining the case of a 70-year-old woman diagnosed with atrial fibrillation and who, at the same time, is diabetic and hypertensive, for which the application offers the following graphic, which would lead to the doctor say something like: "according to what we know, out of every hundred people with their circumstances, within five years, eight will have suffered a serious stroke and sixteen a mild one, but if they agree to take anticoagulants, these figures would drop to a one serious stroke and seven milds, that is, if they take blood thinners, sixteen people like you could save themselves a stroke."

The algorithm then offers, also graphically, information on the different types of anticoagulants, but the accent is on the patient understanding that out of every hundred people of her type who take anticoagulants, in the next five years, nine will have to go to the ER for a haemorrhage, some of them fatal.

An improvement in the quality of clinical care

The study has shown that the shared decision improves the quality of the communication of the care act and the degree of understanding of the patients about atrial fibrillation and the eventuality of anticoagulant treatment, it also provides light to the conflicts in the decision and improves the satisfaction with the received care. Another conclusion is that the practice of shared decisions did not lengthen the duration of the visits.

The evaluations serve not only to validate the support instruments (decision aids) but also to calibrate expectations in an environment of uncertainties and risks that accompany each clinical decision.