Facilitating Shared Decision Making Among Black Patients at Risk for Sudden Cardiac Arrest : A Randomized Clinical Trial

Overview

Journal Ann Intern Med

Specialty General Medicine

Date 2023 Apr 3

PMID 37011387

Authors

Kevin L Thomas

Sana M Al-Khatib

Andrzej S Kosinski

Samuel F Sears Jr

Nancy M Allen LaPointe

Larry R Jackson 2nd

Daniel D Matlock

Daniel Haithcock

B Judson Colley 3rd

David S Hirsh

Eric D Peterson

Affiliations

Soon will be listed here.

Abstract

Background: Racial disparities in implantable cardioverter-defibrillator (ICD) implantation are multifactorial and are partly explained by higher refusal rates.

Objective: To assess the effectiveness of a video decision support tool for Black patients eligible for an ICD.

Design: Multicenter, randomized clinical trial conducted between September 2016 and April 2020. (ClinicalTrials.gov: NCT02819973).

Setting: Fourteen academic and community-based electrophysiology clinics in the United States.

Participants: Black adults with heart failure who were eligible for a primary prevention ICD.

Intervention: An encounter-based video decision support tool or usual care.

Measurements: The primary outcome was the decision regarding ICD implantation. Additional outcomes included patient knowledge, decisional conflict, ICD implantation within 90 days, the effect of racial concordance on outcomes, and the time patients spent with clinicians.

Results: Of the 330 randomly assigned patients, 311 contributed data for the primary outcome. Among those randomly assigned to the video group, assent to ICD implantation was 58.6% compared with 59.4% in the usual care group (difference, -0.8 percentage point [95% CI, -13.2 to 11.1 percentage points]). Compared with usual care, participants in the video group had a higher mean knowledge score (difference, 0.7 [CI, 0.2 to 1.1]) and a similar decisional conflict score (difference, -2.6 [CI, -5.7 to 0.4]). The ICD implantation rate within 90 days was 65.7%, with no differences by intervention. Participants randomly assigned to the video group spent less time with their clinician than those in the usual care group (mean, 22.1 vs. 27.0 minutes; difference, -4.9 minutes [CI, -9.4 to -0.3 minutes]). Racial concordance between video and study participants did not affect study outcomes.

Limitation: The Centers for Medicare & Medicaid Services implemented a requirement for shared decision making for ICD implantation during the study.

Conclusion: A video-based decision support tool increased patient knowledge but did not increase assent to ICD implantation.

Primary Funding Source: Patient-Centered Outcomes Research Institute.

Citing Articles

Depression and Implantable Cardioverter-Defibrillator Implantation in Black Patients at Risk for Sudden Cardiac Death.

Boursiquot B, Young R, Alhanti B, Sullivan 2nd L, Maul A, Khedagi A J Am Heart Assoc. 2024; 13(14):e033291.

PMID: 38979811 PMC: 11292748. DOI: 10.1161/JAHA.123.033291.

Racial and Ethnic Disparities in Implantable Cardioverter-Defibrillator Utilization: A Contemporary Review.

Tertulien T, Bush K, Jackson 2nd L, Essien U, Eberly L Curr Treat Options Cardiovasc Med. 2024; 25(12):771-791.

PMID: 38873495 PMC: 11172403. DOI: 10.1007/s11936-023-01025-z.

Linking Cardiac Psychology and Cardiovascular Medicine via Self-Determination Theory and Shared Decision-Making.

Shaffer J, Matlock D, Boylan J, Vagnini K, Rush C, Martin R J Clin Psychol Med Settings. 2024; .

PMID: 38678122 DOI: 10.1007/s10880-024-10014-8.

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