Abstract
Shared decision-making, central to evidence-based medicine and good patient care, begins and ends with the patient. It is the process by which a clinician and a patient jointly make a health decision after discussing options, potential benefits and harms, and considering the patient’s values and preferences. Patient empowerment is crucial to shared decision-making and occurs when a patient accepts responsibility for his or her health. They can then learn to solve their own problems with information and support from professionals. Patient empowerment begins with the provider acknowledging that patients are ultimately in control of their care and aims to increase a patient’s capacity to think critically and make autonomous, informed decisions about their health. This article explores the various components of shared decision-making in scenarios such as hypertension and hyperlipidemia, heart failure, and diabetes. It explores barriers and the potential for improving medication adherence, disease awareness, and self-management of chronic disease.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Hoffmann TC, Montori VM, Del Mar C. The connection between evidence-based medicine and shared decision making. JAMA. 2014;312(13):1295–6.
Bodenheimer T, Lorig K, Holman H, Grumbach K. Patient self-management of chronic disease in primary care. JAMA. 2002;288(19):2469–75. This article provides evidence from clinical trials that programs that teach self-management are more effective in producing clinical outcomes for patients with chronic conditions and reduces costs.
Anderson RM, Funnell MM. Patient empowerment: myths and misconceptions. Patient Educ Couns. 2010;79(3):277–82.
Fletcher BR, Hinton L, Hartmann-Boyce J, Roberts NW, Bobrovitz N, McManus RJ. Self-monitoring blood pressure in hypertension, patient and provider perspectives: a systematic review and thematic synthesis. Patient Educ Couns. 2015.
Vale MJ, Jelinek MV, Best JD, Dart AM, Grigg LE, Hare DL, et al. Coaching patients On Achieving Cardiovascular Health (COACH): a multicenter randomized trial in patients with coronary heart disease. Arch Intern Med. 2003;163(22):2775–83. This multicenter randomized controlled trial, called COACH study, assessing whether dietitians or nurses who did not prescribe medications could coach patients with coronary heart disease to work with their physicians to achieve the target levels for their total cholesterol, found that this program is highly effective strategy in reducing coronary risk factors in patients coronary heart disease.
Chow CK, Redfern J, Hillis GS, Thakkar J, Santo K, Hackett ML, et al. Effect of lifestyle-focused text messaging on risk factor modification in patients with coronary heart disease: a randomized clinical trial. JAMA. 2015;314(12):1255–63. Randomized control trial that examines the effect of a lifestyle-focused semi personalized support program delivered by mobile phone text message on cardiovascular risk factors which showed improvement in LDL, blood pressure, BMI, increase in physical activity and reduction in smoking.
Montori VM, Brito JP, Murad MH. The optimal practice of evidence-based medicine: incorporating patient preferences in practice guidelines. JAMA. 2013;310(23):2503–4. This article discusses incorporating patient preferences into clinical practice and guidelines. The study recommends that guideline panels should rarely formulate strong recommendations and should be comfortable with ambiguity and how patient preferences and context is considered in formulating the panel’s recommendations.
Katz DH, Intwala SS, Stone NJ. Addressing statin adverse effects in the clinic: the 5 Ms. J Cardiovasc Pharmacol Ther. 2014;19(6):533–42.
Martin SS, Sperling LS, Blaha MJ, Wilson PW, Gluckman TJ, Blumenthal RS, et al. Clinician-patient risk discussion for atherosclerotic cardiovascular disease prevention: importance to implementation of the 2013 ACC/AHA guidelines. J Am Coll Cardiol. 2015;65(13):1361–8. This is a dialogue between the clinician and patient about potential for atherosclerotic cardiovascular disease risk reduction benefits, adverse effects, drug-drug interactions, and patient preferences designed for primary prevention in patients.
Krumholz HM, Amatruda J, Smith GL, Mattera JA, Roumanis SA, Radford MJ, et al. Randomized trial of an education and support intervention to prevent readmission of patients with heart failure. J Am Coll Cardiol. 2002;39(1):83–9.
Annema C, Luttik ML, Jaarsma T. Reasons for readmission in heart failure: perspectives of patients, caregivers, cardiologists, and heart failure nurses. Heart Lung. 2009;38(5):427–34.
Evangelista LS, Lee JA, Moore AA, Motie M, Ghasemzadeh H, Sarrafzadeh M, et al. Examining the effects of remote monitoring systems on activation, self-care, and quality of life in older patients with chronic heart failure. J Cardiovasc Nurs. 2015;30(1):51–7.
Shearer NB, Cisar N, Greenberg EA. A telephone-delivered empowerment intervention with patients diagnosed with heart failure. Heart Lung. 2007;36(3):159–69.
Varming AR, Hansen UM, Andresdottir G, Husted GR, Willaing I. Empowerment, motivation, and medical adherence (EMMA): the feasibility of a program for patient-centered consultations to support medication adherence and blood glucose control in adults with type 2 diabetes. Patient Prefer Adherence. 2015;9:1243–53.
Lee YJ, Shin SJ, Wang RH, Lin KD, Lee YL, Wang YH. Pathways of empowerment perceptions, health literacy, self-efficacy, and self-care behaviors to glycemic control in patients with type 2 diabetes mellitus. Patient Educ Couns. 2015.
James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507–20.
Wright Jr JT, Fine LJ, Lackland DT, Ogedegbe G, Dennison Himmelfarb CR. Evidence supporting a systolic blood pressure goal of less than 150 mm Hg in patients aged 60 years or older: the minority view. Ann Intern Med. 2014;160(7):499–503.
Group SR, Wright Jr JT, Williamson JD, Whelton PK, Snyder JK, Sink KM, et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015;373(22):2103–16.
van Steenkiste B, van der Weijden T, Timmermans D, Vaes J, Stoffers J, Grol R. Patients’ ideas, fears and expectations of their coronary risk: barriers for primary prevention. Patient Educ Couns. 2004;55(2):301–7.
Hibbard JH, Stockard J, Mahoney ER, Tusler M. Development of the Patient Activation Measure (PAM): conceptualizing and measuring activation in patients and consumers. Health Serv Res. 2004;39(4 Pt 1):1005–26.
Aung E, Donald M, Coll JR, Williams GM, Doi SA. Association between patient activation and patient-assessed quality of care in type 2 diabetes: results of a longitudinal study. Health Expect. 2015.
Mosen DM, Schmittdiel J, Hibbard J, Sobel D, Remmers C, Bellows J. Is patient activation associated with outcomes of care for adults with chronic conditions? J Ambul Care Manage. 2007;30(1):21–9.
Fowles JB, Terry P, Xi M, Hibbard J, Bloom CT, Harvey L. Measuring self-management of patients’ and employees’ health: further validation of the Patient Activation Measure (PAM) based on its relation to employee characteristics. Patient Educ Couns. 2009;77(1):116–22.
Ross SE, Lin CT. The effects of promoting patient access to medical records: a review. J Am Med Inform Assoc. 2003;10(2):129–38.
Goldzweig CL, Orshansky G, Paige NM, Towfigh AA, Haggstrom DA, Miake-Lye I, et al. Electronic patient portals: evidence on health outcomes, satisfaction, efficiency, and attitudes: a systematic review. Ann Intern Med. 2013;159(10):677–87.
Kruse CS, Argueta DA, Lopez L, Nair A. Patient and provider attitudes toward the use of patient portals for the management of chronic disease: a systematic review. J Med Internet Res. 2015;17(2), e40.
Hamine S, Gerth-Guyette E, Faulx D, Green BB, Ginsburg AS. Impact of mHealth chronic disease management on treatment adherence and patient outcomes: a systematic review. J Med Internet Res. 2015;17(2), e52.
Irizarry T, DeVito DA, Curran CR. Patient portals and patient engagement: a state of the science review. J Med Internet Res. 2015;17(6), e148.
Kruse CS, Bolton K, Freriks G. The effect of patient portals on quality outcomes and its implications to meaningful use: a systematic review. J Med Internet Res. 2015;17(2), e44.
McAllister M, Dunn G, Payne K, Davies L, Todd C. Patient empowerment: the need to consider it as a measurable patient-reported outcome for chronic conditions. BMC Health Serv Res. 2012;12:157.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
Swetha Kambhampati, Tamara Ashvetiya, Steven Driver, Neil J. Stone, Roger S. Blumenthal, and Seth S. Martin declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Additional information
This article is part of the Topical Collection on Lipid Abnormalities and Cardiovascular Prevention
Rights and permissions
About this article
Cite this article
Kambhampati, S., Ashvetiya, T., Stone, N.J. et al. Shared Decision-Making and Patient Empowerment in Preventive Cardiology. Curr Cardiol Rep 18, 49 (2016). https://doi.org/10.1007/s11886-016-0729-6
Published:
DOI: https://doi.org/10.1007/s11886-016-0729-6