Shared decision-making and the use of decision aids in the management of carotid disease.

Overview

Changes to the National Coverage Determination for carotid stenting now mandates a documented shared decision-making (SDM) interaction between the provider and patient as a prerequisite for reimbursement. Historically, formalized SDM tools to facilitate these discussions have been underutilized in clinical practice among vascular surgeons. Therefore, our objective was to conduct a contemporary review of currently available information surrounding SDM and decision support instruments for patients with carotid disease. To do this, we performed a review of the literature for publications related to SDM or decision aid development for patients with carotid artery disease. Eight studies met inclusion criteria. We determined that patients with carotid disease generally preferred to take an active role in the decision-making process. Factors such as patient understanding of their disease and perceived benefit of the therapy can impact SDM discussions and the ultimate therapeutic decision. The decision aid information and corresponding visual format can influence patient understanding and choice. Furthermore, research describing any SDM and patient preferences regarding transcarotid artery revascularization is lacking. Accordingly, continued development of a disease-specific validated decision aid for patients with carotid stenosis will improve SDM discussions and ensure value-based patient decisions.