title: Quality of decision making is related to decision outcome for patients with cardiac arrhythmia.
abstract: OBJECTIVE
  Clinical consultations with patients should be informed by the evidence-based and involve shared decision making (SDM). We aimed to determine the delivery of SDM by clinicians with patients referred for invasive treatment of cardiac electrical disease and to establish whether decisions made corresponded with patient and referring physician expectations.
  
  
  METHODS
  Forty-nine outpatient consultations with two consultant cardiologists in one large tertiary centre were audio-recorded. Demographic data, diagnosis, reasons for referral and decision reached were compared directly with patient and referring physician expectations. The OPTION instrument was used to measure SDM. Patient expectations and satisfaction were elicited.
  
  
  RESULTS
  Quality of SDM was good (mean OPTION score 49%) and there was broad patient satisfaction. While all patients were suitable for invasive treatment, and the majority (80%, n=39) had been explicitly referred for it, only 59% (n=29) opted to proceed. Consultation quality with respect to SDM was significantly greater for patients choosing a less invasive option.
  
  
  CONCLUSIONS
  These consultations often change expected management. Where decision making in the consultation is of higher quality, patients were more likely to change to a less invasive option.
  
  
  CONCLUSIONS
  Clinicians performing invasive cardiac treatment should be able to demonstrate high quality decision making.
authors.affiliation: Department of Cardiology, Freeman Hospital, Newcastle upon Tyne NE7 7DN, United Kingdom.
authors.forename: Miriam S
authors.initials: MS
authors.lastname: Langseth
authors.forename: Ewen
authors.initials: E
authors.lastname: Shepherd
authors.forename: Richard
authors.initials: R
authors.lastname: Thomson
authors.forename: Stephen
authors.initials: S
authors.lastname: Lord
mesh_terms: D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000628:therapy; D054849:Cardiac Electrophysiology; D003142:Communication; D003657:Decision Making; D022062:Electrophysiologic Techniques, Cardiac; D005194:Family Practice / Q000458:organization & administration; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010358:Patient Participation; D017060:Patient Satisfaction; D018802:Patient-Centered Care; D010817:Physician-Patient Relations; D017064:Process Assessment, Health Care / Q000379:methods*; D011787:Quality of Health Care; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D013637:Tape Recording