The development, implementation, and evaluation of training for health care providers in shared decision making in cardiac surgery

Background: Shared decision making (SDM) is a formalized process in which patient preferences and values are considered along with treatment options to inform medical decisions. Training in SDM has been shown to improve patient comprehension and reduce decisional regret, but has not shown sustained results. We sought to identify barriers to SDM implementation and develop a training program to overcome these challenges. Methods: Guided focus group sessions with former cardiac surgery patients and health care providers (HCPs) were audio recorded and analyzed using thematic analysis. An SDM training module was developed, and interactive training sessions were arranged with cardiac HCPs. Informed consent discussions between surgeons and 118 patients undergoing cardiac surgery (59 in each group) were recorded before and after SDM training. Recordings were analyzed for evidence of SDM using the OPTION-5 scoring tool. Results: We identified 3 barriers to SDM implementation in cardiac surgery: assumed authoritative inferiority, deficits in patient comprehension, and lack of time. The SDM training module was developed to address these barriers and incorporate HCP preferences. We had high HCP participation in training sessions. Mean total OPTION-5 scores of SDM in informed consent discussions increased from 25.46 to 69.53 (p < 0.001) after training implementation, with statistically significant increases in all 5 individual competency categories. Conclusion: We present evidence of a successful initial implementation of SDM training broadly for the health care providers involved in cardiac care, focused on identified barriers to sustainable implementation and accommodating learner preferences.