Assessing the feasibility and quality of shared decision making in China: evaluating a clinical encounter intervention for Chinese patients
Authors Huang RC, Song XT, Wu J, Huang W, Leppin AL, Gionfriddo MR, Liu YX, Boehmer KR, Ting HH, Montori VM
Received 16 June 2016
Accepted for publication 26 August 2016
Published 14 November 2016 Volume 2016:10 Pages 2341—2350
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Naifeng Liu
Rongchong Huang,1,* Xiantao Song,2,* Jian Wu,1 Wei Huang,2 Aaron L Leppin,3 Michael R Gionfriddo,3,4 Yongxian Liu,1 Kasey R Boehmer,3 Henry H Ting,5 Victor M Montori3,6
1Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, 2Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing, People’s Republic of China; 3Knowledge and Evaluation Research Unit, 4Mayo Graduate School, Mayo Clinic, Rochester, MN, 5Value Institute, New York-Presbyterian Hospital, The University Hospital of Columbia and Cornell, New York, NY, 6Division of Endocrinology, Mayo Clinic, Rochester, MN, USA
*These authors contributed equally to this work
Background: The aim of this study was to evaluate the feasibility of using the Statin Choice decision aid to have discussions about starting a statin medication for cardiovascular risk reduction in Chinese patients with stable coronary artery diseases.
Methods: A prospective, pilot study of the Statin Choice decision aid in two teaching hospitals in Northern China was conducted. A total of seven clinicians were enrolled and underwent a 12-hour, group-based, in-person training on shared decision making (SDM) and the Statin Choice decision aid. Then, these clinicians used the Statin Choice decision aid in patients during a clinical encounter. A total of 86 patients aged 40-80 years, who had stable angina, were enrolled. All clinical encounters were video recorded. A team of three researchers viewed and scored all the encounter recordings to evaluate the SDM process and fidelity to the intervention using the OPTION scale and Fidelity scale, respectively. All the patients were followed up for 12 months to record adherence to statin and any major adverse cardiac events (MACEs).
Results: The average scores on the OPTION normalized score and Fidelity scale were 21 (range, 3–32; out of a possible, 48) and 10 (range, 6–10; out of a possible, 10), respectively. This suggested that Chinese clinicians who were using Statin Choice in their patients were able to exhibit behaviors consistent with SDM at a level that is similar to that reported in Western countries. After SDM, the statin adherence was 94.5% (69/73), and the proportion of MACEs was 2.9% (2/69).
Conclusion: Using an encounter decision aid developed in the US, it was feasible to implement SDM in a referral cardiology practice in Mainland China. Further work to ensure that the encounter aid is pertinent to the Chinese population and that SDM is tested in at-risk patients could contribute to the implementation of SDM across Mainland China.
Keywords: Statin Choice, decision aid, stable angina, statin adherence, shared decision making, China
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