Table 4.
Strategies for general practitioners (GPs) to address the barriers and challenges of shared decision-making (SDM) about cardiovascular disease (CVD) medication as identified in this study
| SDM step6 | Key barriers/challenges | How to address barrier/challenges | Example of useful strategies for GPs |
| Creating awareness that options exist and a decision can be made |
Limited awareness that:
There are options to consider (unless prevented by side effects). Patient can share information about goals, preferences and context. |
Acknowledge that past decisions may need to be revised. Make goals explicit, explain that health provider is the medical expert and that the patient is the expert on his/her life, goals and circumstances. |
Consider SDM as an ongoing process7
Collaborative goal setting as the key first SDM step35 55 Preparation for SDM56 |
| Discussing the options and their potential benefits and harms |
Limited knowledge of:
Aims of CVD medication. Potential benefits and harms. How age-related concerns may impact benefit/harm trade off in medication. Limitations of evidence on older people. |
Ensure patients are knowledgeable enough to construct informed preferences. Discuss potential harms as well as benefits. Discuss why it is important to take age-related concerns into account in decision-making about CVD medication. Acknowledge limitations and uncertainties of the evidence. |
Empower patients to ask questions about CVD prevention options (eg, ASK 3)57 58
Use a teach back approach to check understanding59 Use decision aids for CVD prevention47 |
| Exploring preferences for (attributes of) different options | Preferences vary widely (both health-related and with regard to decision involvement).*
Assumption that preferences are known to GP. Cognitive biases (eg, status quo bias, confirmation bias, cognitive dissonance) leading to preferences for medication and focus on benefits over harms. |
Explicitly invite patients to express preferences and link them to different options and potential benefits and harms. Challenge preferences that appear misinformed. |
Use patient-centred communication60
Use decision aids for CVD prevention47 Use tool to prioritise outcomes37 |
| Making the decision | Preference for directive approach, but some want more active involvement. Perception that being informed=being involved. Carer involvement. |
Encourage and support patients to be involved, accept that some may not want to be. Explore involvement of family members/carers. |
Use a triadic SDM approach61 |
*see table 3 for detailed overview of goals, values and preferences.