Deciding with heart

Abstract

Shared decision making is a process in which healthcare professionals and patients decide together on the course of the treatment. Shared decision making enables evidence and patients’ preferences to be taken into account. It improves the patient’s knowledge, understanding and patient-healthcare providers communication. However, various barriers for implementing shared decision making for patients with advanced heart failure were found, which consist of unclarity, uncertainty, lack of training, and lack of time. This thesis focuses on improving the shared decision making process at the Cardiology department at the Amsterdam UMC, location VUmc. Observations and interviews were conducted in the Cardiology department at the VUmc. In order to find similarities and differences between literature research and the current context.
Interviews show that shared decision making partly applies to the current decision making process: although healthcare providers share plenty of information with the patient and family, they share it mostly verbally. Treatment options are explained to the patient multiple times, but no information is given in the written form. The booklet “Deciding with heart” was created to support the communication between healthcare providers and patients in the shared decision making process. It provides information about life-prolonging treatments for patients with advanced heart failure and sensitise them in individuating their values and preferences tackling two of the barriers found in the research: limited understanding amongst people with heart failure and unclarity of the roles in the care team. The booklet can be used to explain the patients’ prognosis and their treatment options in order to support them in the decision making process. The booklet helps to start a conversation between nurses and patients about making the best choice. The booklet was positively evaluated with nurses from the department of Cardiology in the VUmc and the outpatient clinic, and with patient representatives. Patients should receive the booklet during the consultation with a cardiologist, a nurse or a heart failure nurse. The shared decision making process can be improved when physicians decide to stop curative treatments; the booklet should be handed to the patient before in order to empower the patient in making a treatment choice using shared decision making principles.
The booklet can help improve the shared decision making process at the Cardiology department at the Amsterdam UMC, location VUmc. Further research and development are needed to implement the booklet in the Amsterdam UMC effectively, location VUmc to improve the shared decision making process.