PT  - JOURNAL ARTICLE
AU  - Juli Finlay
AU  - Todd Wilson
AU  - Pantea Amin Javaheri
AU  - Winnie Pearson
AU  - Carol Connolly
AU  - Meghan J. Elliott
AU  - Michelle M. Graham
AU  - Colleen M. Norris
AU  - Stephen B. Wilton
AU  - Matthew T. James
TI  - Patient and physician perspectives on shared decision-making for coronary procedures in people with chronic kidney disease: a patient-oriented qualitative study
AID  - 10.9778/cmajo.20200039
DP  - 2020 Oct 01
TA  - CMAJ Open
PG  - E860--E868
VI  - 8
IP  - 4
4099  - http://www.cmajopen.ca/content/8/4/E860.short
4100  - http://www.cmajopen.ca/content/8/4/E860.full
SO  - CMAJ2020 Oct 01; 8
AB  - Background: Patients with chronic kidney disease (CKD) and heart disease face challenging treatment decisions. We sought to explore the perceptions of patients and physicians about shared decision-making for coronary procedures for people with CKD, as well as opinions about strategies and tools to improve these decisions.Methods: We partnered with 4 patients with CKD and 1 caregiver to design and conduct a qualitative descriptive study using semi-structured interviews and content analysis. Patient participants with CKD and either acute coronary syndrome or cardiac catheterization in the preceding year were recruited from a provincial cardiac registry, cardiology wards and clinics in Calgary between March and September 2018. Cardiologists from the region also participated in the study. Data analysis emphasized identifying, organizing and describing themes found within the data.Results: Twenty patients with CKD and 10 cardiologists identified several complexities related to bidirectional information exchange needed for shared decision-making. Themes identified by both patients and physicians included challenges synthesizing best evidence, variable patient knowledge seeking, timeliness in the acute care setting and influence of roles on decision-making. Themes identified by physicians related to processes and tools to help support shared decision-making in this setting included personalization to reflect the variability of risks and heterogeneity of patient preferences as well as allowing for physicians to share their clinical judgment.Interpretation: There are complexities related to bidirectional information exchange between patients with CKD and their physicians for shared decision-making about coronary procedures. Processes and tools to facilitate shared decision-making in this setting require personalization and need to be time sensitive.