Shared decision making is the process through which clinicians and patients share information with each other and work toward decisions about treatment chosen from medically reasonable options that are aligned with the patients’ values, goals, and preferences.
For patients with advanced heart failure, shared decision making has become both more challenging and more crucial as duration of disease and treatment options have increased.
Difficult discussions now will simplify difficult decisions in the future.
Ideally, shared decision making is an iterative process that evolves over time as a patient’s disease and quality of life change.
Attention to the clinical trajectory is required to calibrate expectations and guide timely decisions, but prognostic uncertainty is inevitable and should be included in discussions with patients and caregivers.
An annual heart failure review with patients should include discussion of current and potential therapies for both anticipated and unanticipated events.
Discussions should include outcomes beyond survival, including major adverse events, symptom burden, functional limitations, loss of independence, quality of life, and obligations for caregivers.
As the end of life is anticipated, clinicians should take responsibility for initiating the development of a comprehensive plan for end-of-life care consistent with patient values, preferences, and goals.
Assessing and integrating emotional readiness of the patient and family is vital to effective communication.
Changes in organizational and reimbursement structures are essential to promote high-quality decision making and delivery of patient-centered health care.
