Lewis Krystina B, Carroll Sandra L, Birnie David, Stacey Dawn, Matlock Daniel D
aSchool of Nursing, University of OttawabUniversity of Ottawa Heart Institute, OttawacSchool of Nursing, McMaster University, HamiltondOttawa Hospital Research Institute, Ottawa, CanadaeDepartment of Medicine, School of Medicine, University of Colorado, Aurora, Colorado, USA.
Curr Opin Cardiol. 2018 Jan;33(1):42-49. doi: 10.1097/HCO.0000000000000464.
Strong recommendations exist for implantable cardioverter defibrillators (ICD) in appropriately selected patients. Yet, patient preferences are not often incorporated when decisions about ICD therapy are made. Literature published since 2016 was reviewed aiming to discuss current advances and ongoing challenges with ICD decision-making in adults, discuss shared decision-making (SDM) as a strategy to incorporate preference diagnoses, summarize current evidence on effective interventions to facilitate SDM, and identify opportunities for research and practice.
Advances in risk stratification can identify patients who will most and least likely benefit from the ICD. Interventions to support SDM are emerging. These interventions present options, the risks, and the benefits of each option, and elicit patients' values and preferences regarding possible outcomes.
Appropriate patient selection for initial or continued ICD therapy is multifactorial. It requires accurate clinical diagnosis using careful risk stratification and accurate preference diagnosis based upon the patient's preferences. SDM aims to unite the elements that constitute these two equally important diagnoses. High-quality decision-making will be difficult to achieve if patients lack or misunderstand information, and if evolving patient preferences are not incorporated when making decisions.
对于经过适当筛选的患者，植入式心脏复律除颤器（ICD）有明确的推荐意见。然而，在做出ICD治疗决策时，患者的偏好往往未被纳入考虑。对2016年以来发表的文献进行综述，旨在讨论成人ICD决策的当前进展和持续挑战，探讨将共同决策（SDM）作为纳入偏好诊断的策略，总结促进SDM的有效干预措施的当前证据，并确定研究和实践的机会。
风险分层的进展能够识别出最有可能和最不可能从ICD中获益的患者。支持SDM的干预措施正在出现。这些干预措施呈现各种选择、每种选择的风险和益处，并引出患者对可能结果的价值观和偏好。
对于初始或持续的ICD治疗，合适的患者选择是多因素的。这需要通过仔细的风险分层进行准确的临床诊断，并基于患者的偏好进行准确的偏好诊断。SDM旨在将构成这两种同样重要诊断的要素结合起来。如果患者缺乏或误解信息，以及在决策时未纳入不断变化的患者偏好，将难以实现高质量的决策。
