Quality of decision making is related to decision outcome for patients with cardiac arrhythmia

Objective: Clinical 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. Methods: Forty-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. Results: Quality 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. Conclusion: These 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 implications: Clinicians performing invasive cardiac treatment should be able to demonstrate high quality decision making. (C) 2011 Elsevier Ireland Ltd. All rights reserved.