Clinicians perspectives towards the application of shared decision making in tertiary CVD care including the multidisciplinary heart team.

Background: Shared decision-making (SDM), is a sine qua non in healthcare. Yet, it has been difficult to implement SDM in routine practice for patients with cardiovascular disease(CVD). To improve this, we aimed to determine HCPs perspectives on their SDM behavior in CVD context and influencing factors, and with special focus on multidisciplinary heartteams. Methods: Cross-sectional survey between March-July 2022 with cardiologists, cardiothoracic surgeons, medical residents, and nurse practitioners within two of the largest tertiary cardiac Centers in the Netherlands. Descriptive statistics were used for quantitative data; open-ended questions were thematically analyzed. Results: 72 participants completed the survey. Respondents indicated to know "very well" what SDM entailed (70 %) and had positive attitudes towards SDM (90 %). Participants used SDM in daily practice (SDMQDoc = 73/100), but indicated that more SDM could be performed (67 %). In self-reported definitions of SDM, explaining the consequences of treatment (step 2) and discussing patients' preferences (step 3) were most frequently mentioned. Barriers for SDM were patient and process characteristics: e.g. lack of time (70 %), understaffing (35 %). The heartteam was seen as potential facilitator, but its current role and process were seen as barrier for SDM. Facilitators for SDM were managerial support (16 %), decision aids (28 %), and SDM-training (13 %). Conclusion: HCPs reported high knowledge and application of SDM, but overlooked some steps in the SDM-process. A multifaceted intervention is needed focusing on awareness, enhancing communication skills and system level support. Specific improvements were identified to improve SDM for patients discussed by the multidisciplinary heartteam.