Patient perspectives

14.2. Shared decision-making

Shared decision-making is a process, during which the patient and a healthcare professional work together to make an informed decision about the patient’s care.

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During this process, information is pro- vided, comprehension checked, and the patient is given an opportunity to ask questions in order to equip them with the tools needed to make an informed decision.

Using a shared decision-making approach during the consent process allows the patient’s preferences to be established.

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Discovery of the patient’s concerns, goals, preferences, and values should be a central component of this process. The use of validated decision aids and audio-visual tools may also be helpful to facilitate informed consent and promote patient involvement.

^884–887

14.3. Informed consent

Informed consent should include the components listed in Supplementary data online, Table S18.

^885,888

Informed consent is an op- portunity to educate patients about the proposed procedure, the asso- ciated risks and benefits, and any available alternative interventions or treatments.

^886,887

Assessment of the patient’s understanding of the in- formation given to them during the informed consent process using the

‘teach back’ technique should be considered (Supplementary data online, Figure S6).

885,889–891

The teach back method assesses under- standing by asking patients to state in their own words what they need to know or do about their health.

Informed consent is an ethical and legal obligation for medical practi- tioners and is required before any invasive procedure. The information

Premorbid condition

Consider all risk factors

Establish medical history and prior medications

Consider psychosocial

factors

Hospital

admission Individualize care at triage

Perform a person-centred clinical assessment

Employ shared decision-making

Preparing for

discharge Explain regarding long-term treatment

Educate about lifestyle modification

Consider mental and emotional health

At every stage, consider physical and psychosocial needs Taking a person-centred approach to the ACS journey

Figure 19 A person-centred approach to the ACS journey. ACS, acute coronary syndrome.

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should be provided in a simple and clear format. In patients undergoing emergency invasive angiography, a shortened informed consent pro- cess is appropriate. If a shortened informed consent process has been used, it is important that there is contact with the patient and/

or family member after the intervention when the patient is physically and psychologically stable or following the death of the patient.

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Further information can be found in the Supplementary data online.

14.4. Research participation and consent in the acute setting

With unstable ACS patients, it is often challenging to obtain their con- sent for emergency procedures—and even more challenging to enrol in clinical trials due to a number of factors, including the necessity for prompt clinical care, increased pain and stress levels, and impairment of consciousness. Where clinical trials are conducted, patient involve- ment in enrolment decisions is paramount, if possible.

^893,894

A short

witnessed verbal consent, followed by written consent after the acute phase, has been shown to be less stressful and more positively re- ceived than written consent in the acute setting.

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The research and consent process must follow the ethical and legal requirements in the relevant country. Further information can be found in the Supplementary data online.

14.5. Patient satisfaction and expectations

Focusing healthcare around the needs and preferences of patients has the potential to improve clinical outcomes, quality of care and patient satisfaction, while decreasing healthcare costs and health disparities.

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Patient perception of care is built on interpersonal interactions, the quality of clinical communication, delivery of care, and the administra- tive management of care. ACS patient expectations are summarized in Figure 20 and further information can be found in the Supplementary data online, Table S19.

...their ACS symptoms to be recognised

...high quality, effective and safe care delivered

by professionals

…the right care at the right time

…their physical, mental and emotional wellbeing

to be considered

…clear, comprehensible

information …shared decision

making and respect for their preferences

…consideration of, and support for, their family and carers

…attention to both their physical and environmental needs

…a clean and safe hospital environment

ACS patients expect…

Figure 20 Acute coronary syndrome patient expectations. ACS, acute coronary syndrome.

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14.6. Patient-reported outcome measures and patient-reported experience

measures

Understanding and measuring patient expectations and health out- comes using patient-reported outcome measures (PROMs) and pa- tient-reported experience measures (PREMs) is central to improving patient satisfaction and delivering patient-centred care.

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The quality of care for ACS patients should be measured during the patient’s jour- ney from initial presentation until discharge. Further information can be found in the Supplementary data online. Further information on PROMs and PREMs is also provided in the Supplementary data online.

14.7. Preparation for discharge

Many ACS patients may not be fully aware of what has happened to

them and how to best manage their healthcare after discharge, leading

to them both wanting and needing more information upon dis-

charge.

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Cognitive impairment can occur as a complication of ACS

and some patients may have difficulty with instructions for care when

transitioning towards discharge home.

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Therefore, discharge infor-

mation should be provided in both verbal and written formats and

should include a discharge letter outlining the key components of the

evidence-based discharge plan (Supplementary data online,

Table S20).

^898–901

Some important messages aimed at patients on

how to improve their heart health after ACS are demonstrated in

Supplementary data online, Figure S5. Moreover, following an ACS

event, anxiety and depression are frequently encountered and confer

an increased risk of non-adherence to medications and lifestyle changes,

subsequent MACE, and death.

^902–904

Non-adherence also generally in-

creases over time, which has additional impact on clinical outcomes.

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Assessing and identifying these patients and intervening with onward

psychological referral is recommended.

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Further information can be

found in the Supplementary data online. A summary of patient con-

cerns and educational needs throughout their ACS journey is also pro-

vided in Supplementary data online, Figure S7.