Patient-centered Care: Including the Patient in Medication Decision-making
These new drugs and complex patients highlight the necessity for a new clinical paradigm to help balance the risk of GIB versus the clear cardiac benefit of antithrombotic agents prescribed in elderly patients. We can no longer think in terms of clinical silos with the cardiologist and the gastroenterologist working at cross-purposes, independently and without consideration of the patient's preferences for care. A multidisciplinary approach to risk-benefit management is critical and best achieved when a cardiologist and a gastroenterologist comanage high-risk cardiac patients together. Regardless of the nature of the multidisciplinary team, physicians cannot lose focus on the most important person on the team, the patient. He or she alone will reap potential clinical benefit and suffer the consequences of adverse drug events. Inclusion of the patient's perspective in medical decision-making is a key guiding principle of patient-centered care.
Research among cardiac patients demonstrates their desire to be engaged in the medication decision-making. Data published recently in Circulation endorse shared decision-making to increase the likelihood that patients receive the care they need in a manner that is consistent with the best available clinical evidence, while still being respectful of the individual's values and preferences. During shared decision-making, patients and their providers engage in a deliberate process of information exchange regarding preferences and goals of care. Patients engage in the process to the degree they are willing, making explicit their values and preferences to reach a consensual decision with clinicians regarding a shared treatment plan.
Among cardiac patients prescribed CAT, a patient's experience and perception of drug regimens will change over time as they gain experience with the potential risks and benefits. Data have shown that experiential knowledge of CAT is likely to influence future adherence behaviors to prescribed drug regimens and adverse drug event monitoring. Given the likelihood that a patient's perceptions of risk-benefit associated with CAT will change over time, shared decision-making should not be considered a static event. Rather, it should be viewed as an iterative process, involving patient-doctor negotiation, revisited periodically as the patient experiences new clinical events that will undoubtedly shape their priorities for cardioprophylaxis versus GIB prevention.