The design and development of an encounter tool to support shared decision making about preventing cardiovascular events

Abstract

Patients at high risk for cardiovascular disease (CVD) tend to receive less intensive preventive care. Clinical practice guidelines recommend shared decision making (SDM) to improve the quality of primary CVD prevention. There are tools for use during the clinical encounter that promote SDM, but, to our knowledge, there are no SDM encounter tools that support conversations about available lifestyle and pharmacological options that can lead to preventive care that is congruent with patient goals and CVD risk. Using the best available evidence and human-centered design (iterative design in the context of ultimate use with users), our team developed a SDM encounter tool, CV Prevention Choice. Each subsequent version during the iterative development process was evaluated in terms of content, usefulness, and usability by testing it in real preventive encounters. The final version of the tool includes a calculator that estimates the patient's risk of a major atherosclerotic CVD event in the next 10 years. Lifestyle and medication options are presented, alongside their pros, cons, costs, and other burdens. The risk reduction achieved by the selected prevention program is then displayed to support collaborative deliberation and decision making. A U.S. multicenter trial is estimating the effectiveness of CV Prevention Choice in achieving risk-concordant CV prevention while identifying the best strategies for increasing the adoption of the SDM encounter tool and its routine use in practice.

Keywords: Cardiovascular disease prevention; Decision aids; Encounter tools; Shared decision making.

Fig. 1

Screens of the CV Prevention Choice tool and their purpose in the conversation. This figure shows six screens of the CV Prevention Choice tool and the functional component of SDM conversations that it aims to support: 1) Recognition and characterization of a problem (screen showing the patient’s situation at baseline and 10-year ASCVD risk at baseline), 2) Identifying potential ways of responding (screen showing the 10-year ASCVD risk at baseline and two approaches for risk reduction), 3) Deliberating between options (screen showing lifestyle and medication options), 4) Concluding in a plan that makes intellectual, practical, and emotional sense (screen showing revised 10-year ASCVD risk after selecting components of the prevention plan and documentation of the conversation and decisions made).