Table 5:

Summary, Gaps and Future Directions

Measurement of SDM and Outcomes	Shared decision making (SDM) has been shown to improve patient-reported outcomes and quality of decision making, but only rarely demonstrates improvement in clinical endpoints.
	Demonstration of improvement in measurable clinical outcomes is a major gap in the field of SDM and is in need of further research, ideally in the form of randomized clinical trials.
	SDM interventions implemented across integrated healthcare systems through the electronic health record (EHR) may yield data for correlation with clinical outcomes.
SDM Tools and Interventions	Development of SDM tools has proliferated, including for arrhythmia management, but certification remains lacking. Decision aids should ideally be appraised for quality and effectiveness using measures such as the International Patient Decision Aid Standards.
	Future development of decision aids should ideally be patient-centered, tested in diverse populations (age, sex, race/ethnicity, socioeconomic status), actively incorporate patient input, and account for variable health literacy/numeracy and psychological and cultural barriers to care.
	Atrial fibrillation and reduction of stroke risk using oral anticoagulants or LAAC is a major focus of SDM interventions. An ongoing need and challenge is demonstration of improvement in clinical outcomes, treatment rates and medication adherence.
	The complexity of clinical discussions surrounding implantable devices and invasive procedures will ideally utilize support tools that evolve with clinical evidence and recommendations, streamline efficiently with clinical practice, and naturally personalize recommendations through integration from the EHR.
Implementation and Dissemination of SDM	SDM interventions are more likely to be successfully disseminated when integrated into existing clinical processes of multidisciplinary teams, appraised in the context of system-wide adoption, and endorsed by specialty societies
	Implementation of SDM will require intentional training of clinicians.
	Wider dissemination of SDM interventions may occur when they are designed to address cultural barriers, health literacy, and psychological barriers.
	Requiring documentation of SDM for healthcare reimbursement should be based on scientific evidence that SDM yields improvement in patient-reported or clinical outcomes.
	Generation of data on the impact of SDM on outcomes is limited by suboptimal adoption of SDM in the absence of linkage to reimbursement, but gaps in need of further research may be facilitated where SDM is implemented across healthcare systems andEHRs. Additional data on the impact of SDM may further motivate clinicians to employ and increase skills in SDM.