Shared decision-making

• Shared decision-making is a collaborative process that allows patients and their physicians to make healthcare treatment decisions together

• The process considers the best scientific evidence available, as well as the patients' values and preferences¹

The Centers for Medicare and Medicaid Services (CMS) encourages the use of an evidence-based tool in any physician and patient discussions to help document the appropriateness of left atrial appendage closure (LAAC) as a non-pharmacological treatment option in comparing the risk-benefit to anticoagulants.  

• Patient-provider discussions may uncover barriers to change that include physical pain, emotional difficulties, financial concerns, and lack of confidence in one’s ability to change 
• These and other barriers can then be addressed so that a realistic personal prevention plan is formulated with specific and achievable outcomes 

In clinical scenarios characterized by more than one viable treatment or screening option, providers facilitate shared decision-making by:  

• Encouraging patients to communicate what they care about 
• Providing decision aids that raise the patient’s awareness and understanding of treatment options and possible outcomes 

Each step of the SHARE approach contributes to its success in evidence-based treatment decisions.²

• A formal shared decision-making interaction with an independent non-interventional physician using an evidence-based decision tool is recommended for patients with non-valvular atrial fibrillation (NVAF) prior to LAAC³

• The shared decision-making interaction must also be documented in the medical record

• The patient must be suitable for short-term warfarin but deemed unable to take long-term oral anticoagulation (OAC) following the conclusion of shared decision-making, as LAAC is only covered as a second-line therapy to OACs