21 A Toolkit for Health Care Professionals Unmet Needs in Hypertension Shared Decision-Making Decision-making that is equally shared by patient and clinician(s) is an effective approach to improving outcomes in multiple diseases and is currently recommended in cardiovascular guidelines as well as a recent scientific statement from the AHA. The shift to shared decision-making (SDM) is part of a larger move to patient-centered care, which puts each patient’s individual health needs and preferences in outcomes at the center of all care decisions.25-Introduction SDM is a communication process by which patients and clinicians collaborate to choose tests, treatments and care plans that most align with the specific patient’s preferences and values. A growing body of evidence supports the use of SDM to improve cardiovascular outcomes. The “2019 ACC [American College of Cardiology]/AHA Clinical Performance and Quality Measures for Adults With High Blood Pressure” singled out SDM as a patient-centered approach to control BP.25-Introduction SDM is intended to ensure that the patient has the knowledge and tools to make good decisions about their health while minimizing later decisional regret or conflict and using their clinician’s assistance and clinical expertise.25-Models of SDM Shared decision-making requires three key components to be effective: 1. Clear communication of unbiased medical evidence on the risks and benefits of medical interventions and reasonable alternatives, including no intervention at all. 2. Clinical expertise provided in a way that tailors the evidence for the specific patient. 3. Explicit inclusion of the patient’s values, goals and preferences, as well as the potential treatment burdens in the decision-making process.25-Models of SDM SDM can involve multiple interactions and should facilitate the inclusion of the patient’s own support network, such as family, friends and other health care clinicians who have relevant information and/or clinical expertise.25-Models of SDM SDM is not limited to face-to-face interactions. It can happen during telemedicine and other virtual visits, web portals with patient decision aids or support tools and secure email or chat.25-Models of SDM It is proven that SDM can improve outcomes in hypertension care. “Medication Adherence and Blood Pressure Control: A Scientific Statement From the American Heart Association” cited multiple studies demonstrating that a therapeutic alliance between patient and clinician and the degree to which treatment decisions are patient-centered all affect treatment adherence and BP control. Patients who have participated in medication decisions are more adherent than patients who are not part of the decision-making process.26-Risk Factors and Predictors of Medication Adherence The effects of SDM have been studied in multiple populations, including adults who have or are at risk for developing CVD, athletes who have or are at risk for CVD and other groups.25-Effect of SDM Across the Cardiovascular Spectrum Shared decision-making can and should be incorporated into the continuum of hypertension treatment beginning with lifestyle modifications and the most appropriate first-line medications considered in primary care. SDM has been shown to reduce both smoking and BP in young males who already are diagnosed with hypertension and have been prescribed antihypertensive medications.27-Outcome changes of the whole group BP reduction and CVD risk reduction were more pronounced in patients with stage 2 hypertension.27-Outcome changes of patients with hypertension graded 2 Similarly, adults treated for hypertension in Federally Qualified Health Centers (FQHCs) — many of which are subject to adverse SDOH, such as low income and from underrepresented racial and ethnic groups — are nearly three times more likely to achieve BP control after six months of SDM compared to standard care.28-Introduction, Discussion, Table 2
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