title: Shared decision-making following disclosure of coronary heart disease genetic risk: results from a randomized clinical trial.
abstract: Whether disclosure of genetic risk for coronary heart disease (CHD) influences shared decision-making (SDM) regarding use of statins to reduce CHD risk is unknown. We randomized 207 patients, age 45-65 years, at intermediate CHD risk, and not on statins, to receive the 10-year risk of CHD based on conventional risk factors alone (n=103) or in combination with a genetic risk score (n=104). A genetic counselor disclosed this information followed by a physician visit for SDM regarding statin therapy. A novel decision aid was used in both encounters to disclose the CHD risk estimates and facilitate SDM regarding statin use. Patients reported their decision quality and physician visit satisfaction using validated surveys. There were no statistically significant differences between the two groups in the SDM score, satisfaction with the clinical encounter, perception of the quality of the discussion or of participation in decision-making and physician visit satisfaction scores. Quantitative analyses of a random subset of 80 video-recorded encounters using the OPTION5 scale also showed no significant difference in SDM between the two groups. Disclosure of CHD genetic risk using an electronic health record-linked decision aid did not adversely affect SDM or patients' satisfaction with the clinical encounter.
  
  
  
  NCT01936675; Results.
authors.affiliation: Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Hayan
authors.initials: H
authors.lastname: Jouni
authors.affiliation: Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Raad A
authors.initials: RA
authors.lastname: Haddad
authors.affiliation: Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Tariq S
authors.identifier: 0000-0002-7455-1978
authors.initials: TS
authors.lastname: Marroush
authors.affiliation: Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Sherry-Ann
authors.initials: SA
authors.lastname: Brown
authors.affiliation: Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Teresa M
authors.initials: TM
authors.lastname: Kruisselbrink
authors.affiliation: Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Erin E
authors.initials: EE
authors.lastname: Austin
authors.affiliation: Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Khader
authors.initials: K
authors.lastname: Shameer
authors.affiliation: Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Emma M
authors.initials: EM
authors.lastname: Behnken
authors.affiliation: Division of Primary Care Internal Medicine and Knowledge Delivery Center, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Rajeev
authors.initials: R
authors.lastname: Chaudhry
authors.affiliation: Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Victor M
authors.initials: VM
authors.lastname: Montori
authors.affiliation: Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Iftikhar J
authors.initials: IJ
authors.lastname: Kullo
mesh_terms: D003327:Coronary Disease / Q000235:genetics*; D003657:Decision Making; D030881:Disclosure; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000235:genetics; D017060:Patient Satisfaction; D010820:Physicians; D012307:Risk Factors
keywords: Clinical Research; Coronary Artery Disease; Polymorphism, Genetic; Risk