• Miriam S Langseth, Ewen Shepherd, Richard Thomson, and Stephen Lord.
• Department of Cardiology, Freeman Hospital, Newcastle upon Tyne NE7 7DN, United Kingdom.
• Patient Educ Couns. 2012 Apr 1; 87 (1): 49-53.

ObjectiveClinical consultations with patients should be informed by the evidence-based and involve shared decision making (SDM). We aimed to determine the delivery of SDM by clinicians with patients referred for invasive treatment of cardiac electrical disease and to establish whether decisions made corresponded with patient and referring physician expectations.MethodsForty-nine outpatient consultations with two consultant cardiologists in one large tertiary centre were audio-recorded. Demographic data, diagnosis, reasons for referral and decision reached were compared directly with patient and referring physician expectations. The OPTION instrument was used to measure SDM. Patient expectations and satisfaction were elicited.ResultsQuality of SDM was good (mean OPTION score 49%) and there was broad patient satisfaction. While all patients were suitable for invasive treatment, and the majority (80%, n=39) had been explicitly referred for it, only 59% (n=29) opted to proceed. Consultation quality with respect to SDM was significantly greater for patients choosing a less invasive option.ConclusionThese consultations often change expected management. Where decision making in the consultation is of higher quality, patients were more likely to change to a less invasive option.Practice ImplicationsClinicians performing invasive cardiac treatment should be able to demonstrate high quality decision making.Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

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